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Hetastarch co-loading is as effective as pre-loading for the prevention of hypotension following spinal anesthesia for cesarean delivery.
Int J Obstet Anesth 2009; 18(2):150-5IJ

Abstract

BACKGROUND

Pre-loading with hetastarch decreases the incidence and severity of hypotension after spinal anesthesia for cesarean delivery. However, pharmacokinetic studies with crystalloid predict that fluid loading should be more efficacious if rapidly administered immediately after induction of spinal anesthesia. The aim of this study was to compare pre- and co-loading of hetastarch for the prevention of hypotension following spinal anesthesia for cesarean delivery.

METHODS

Forty-six healthy term parturients scheduled for cesarean delivery were randomized to receive 500 mL of 6% hetastarch intravenously, either slowly before spinal anesthesia (pre-loading) or as quickly as possible immediately after spinal anesthesia (co-loading). Systolic blood pressure was maintained at or above 90% of baseline with intravenous vasopressor boluses (ephedrine 5mg/mL+phenylephrine 25 microg/mL). The primary outcome was the volume of vasopressor mix required. Secondary outcomes included blood pressure and heart rate changes, time to first vasopressor use, nausea or vomiting, and neonatal outcomes (umbilical artery and vein pH, Apgar scores).

RESULTS

The pre-loading group used 3.5+/-2 mL (mean+/-SD) of vasopressor mixture compared with 3.2+/-3 mL in the co-loading group (P=0.6). There were no differences in any important maternal hemodynamic or neonatal outcome values between the two study groups.

CONCLUSION

Hetastarch co-loading is as effective as pre-loading for the prevention of hypotension after spinal anesthesia for cesarean delivery. Surgery need not be delayed to allow a predetermined pre-load to be administered before induction of spinal anesthesia.

Authors+Show Affiliations

Department of Anesthesiology, Stanford University School of Medicine, Stanford, California 94305, USA. bcarvalho@stanford.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

19223168

Citation

Carvalho, B, et al. "Hetastarch Co-loading Is as Effective as Pre-loading for the Prevention of Hypotension Following Spinal Anesthesia for Cesarean Delivery." International Journal of Obstetric Anesthesia, vol. 18, no. 2, 2009, pp. 150-5.
Carvalho B, Mercier FJ, Riley ET, et al. Hetastarch co-loading is as effective as pre-loading for the prevention of hypotension following spinal anesthesia for cesarean delivery. Int J Obstet Anesth. 2009;18(2):150-5.
Carvalho, B., Mercier, F. J., Riley, E. T., Brummel, C., & Cohen, S. E. (2009). Hetastarch co-loading is as effective as pre-loading for the prevention of hypotension following spinal anesthesia for cesarean delivery. International Journal of Obstetric Anesthesia, 18(2), pp. 150-5. doi:10.1016/j.ijoa.2008.12.006.
Carvalho B, et al. Hetastarch Co-loading Is as Effective as Pre-loading for the Prevention of Hypotension Following Spinal Anesthesia for Cesarean Delivery. Int J Obstet Anesth. 2009;18(2):150-5. PubMed PMID: 19223168.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hetastarch co-loading is as effective as pre-loading for the prevention of hypotension following spinal anesthesia for cesarean delivery. AU - Carvalho,B, AU - Mercier,F J, AU - Riley,E T, AU - Brummel,C, AU - Cohen,S E, Y1 - 2009/02/14/ PY - 2008/06/05/received PY - 2008/10/25/revised PY - 2008/12/08/accepted PY - 2009/2/19/entrez PY - 2009/2/19/pubmed PY - 2009/6/27/medline SP - 150 EP - 5 JF - International journal of obstetric anesthesia JO - Int J Obstet Anesth VL - 18 IS - 2 N2 - BACKGROUND: Pre-loading with hetastarch decreases the incidence and severity of hypotension after spinal anesthesia for cesarean delivery. However, pharmacokinetic studies with crystalloid predict that fluid loading should be more efficacious if rapidly administered immediately after induction of spinal anesthesia. The aim of this study was to compare pre- and co-loading of hetastarch for the prevention of hypotension following spinal anesthesia for cesarean delivery. METHODS: Forty-six healthy term parturients scheduled for cesarean delivery were randomized to receive 500 mL of 6% hetastarch intravenously, either slowly before spinal anesthesia (pre-loading) or as quickly as possible immediately after spinal anesthesia (co-loading). Systolic blood pressure was maintained at or above 90% of baseline with intravenous vasopressor boluses (ephedrine 5mg/mL+phenylephrine 25 microg/mL). The primary outcome was the volume of vasopressor mix required. Secondary outcomes included blood pressure and heart rate changes, time to first vasopressor use, nausea or vomiting, and neonatal outcomes (umbilical artery and vein pH, Apgar scores). RESULTS: The pre-loading group used 3.5+/-2 mL (mean+/-SD) of vasopressor mixture compared with 3.2+/-3 mL in the co-loading group (P=0.6). There were no differences in any important maternal hemodynamic or neonatal outcome values between the two study groups. CONCLUSION: Hetastarch co-loading is as effective as pre-loading for the prevention of hypotension after spinal anesthesia for cesarean delivery. Surgery need not be delayed to allow a predetermined pre-load to be administered before induction of spinal anesthesia. SN - 1532-3374 UR - https://www.unboundmedicine.com/medline/citation/19223168/Hetastarch_co_loading_is_as_effective_as_pre_loading_for_the_prevention_of_hypotension_following_spinal_anesthesia_for_cesarean_delivery_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0959-289X(09)00002-8 DB - PRIME DP - Unbound Medicine ER -