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Preload or coload for spinal anesthesia for elective Cesarean delivery: a meta-analysis.
Can J Anaesth 2010; 57(1):24-31CJ

Abstract

BACKGROUND

Hypotension following spinal anesthesia for Cesarean delivery is common. Fluid loading is recommended to prevent hypotension, but preload is often ineffective. In non-pregnant patients, coloading has been shown to better maintain cardiac output after spinal anesthesia. The purpose of this meta-analysis was to determine whether the timing of the fluid infusion, before (preload) or during (coload) induction of spinal anesthesia for Cesarean delivery, influences the incidence of maternal hypotension or neonatal outcome.

METHODS

We retrieved randomized controlled trials that compared a fluid preload with coload in patients undergoing spinal anesthesia for elective Cesarean delivery. We graded the articles for quality of reporting (maximum score = 5) and recorded the incidence of hypotension, lowest blood pressure, the incidence of maternal nausea and vomiting, umbilical cord pH, and Apgar scores. We combined the results using random effects modelling.

RESULTS

We retrieved eight studies comprised of 518 patients. The median quality score for the published studies was three. The incidence of hypotension in the coload group was 159/268 (59.3%) compared with 156/250 (62.4%) in the preload group (odds ratio [OR] = 0.93; 95% confidence interval [CI] 0.54-1.6). There were no significant differences between groups in any of the other outcomes.

CONCLUSIONS

It is unnecessary to delay surgery in order to deliver a preload of fluid. Regardless of the fluid loading strategy, the incidence of maternal hypotension is high. Prophylactic or therapeutic vasopressors may be required in a significant proportion of patients.

Authors+Show Affiliations

Division of Obstetrical Anesthesia and the Obstetrical Anesthesia Research Unit of the Sunnybrook Research Institute, Sunnybrook Health Sciences Centre at Women's College Hospital, University of Toronto, Toronto, Ontario, M5S 1B2, Canada.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis

Language

eng

PubMed ID

19859776

Citation

Banerjee, Arnab, et al. "Preload or Coload for Spinal Anesthesia for Elective Cesarean Delivery: a Meta-analysis." Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie, vol. 57, no. 1, 2010, pp. 24-31.
Banerjee A, Stocche RM, Angle P, et al. Preload or coload for spinal anesthesia for elective Cesarean delivery: a meta-analysis. Can J Anaesth. 2010;57(1):24-31.
Banerjee, A., Stocche, R. M., Angle, P., & Halpern, S. H. (2010). Preload or coload for spinal anesthesia for elective Cesarean delivery: a meta-analysis. Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie, 57(1), pp. 24-31. doi:10.1007/s12630-009-9206-7.
Banerjee A, et al. Preload or Coload for Spinal Anesthesia for Elective Cesarean Delivery: a Meta-analysis. Can J Anaesth. 2010;57(1):24-31. PubMed PMID: 19859776.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Preload or coload for spinal anesthesia for elective Cesarean delivery: a meta-analysis. AU - Banerjee,Arnab, AU - Stocche,Renato M, AU - Angle,Pamela, AU - Halpern,Stephen H, Y1 - 2009/10/27/ PY - 2009/07/23/received PY - 2009/10/13/accepted PY - 2009/10/28/entrez PY - 2009/10/28/pubmed PY - 2010/3/31/medline SP - 24 EP - 31 JF - Canadian journal of anaesthesia = Journal canadien d'anesthesie JO - Can J Anaesth VL - 57 IS - 1 N2 - BACKGROUND: Hypotension following spinal anesthesia for Cesarean delivery is common. Fluid loading is recommended to prevent hypotension, but preload is often ineffective. In non-pregnant patients, coloading has been shown to better maintain cardiac output after spinal anesthesia. The purpose of this meta-analysis was to determine whether the timing of the fluid infusion, before (preload) or during (coload) induction of spinal anesthesia for Cesarean delivery, influences the incidence of maternal hypotension or neonatal outcome. METHODS: We retrieved randomized controlled trials that compared a fluid preload with coload in patients undergoing spinal anesthesia for elective Cesarean delivery. We graded the articles for quality of reporting (maximum score = 5) and recorded the incidence of hypotension, lowest blood pressure, the incidence of maternal nausea and vomiting, umbilical cord pH, and Apgar scores. We combined the results using random effects modelling. RESULTS: We retrieved eight studies comprised of 518 patients. The median quality score for the published studies was three. The incidence of hypotension in the coload group was 159/268 (59.3%) compared with 156/250 (62.4%) in the preload group (odds ratio [OR] = 0.93; 95% confidence interval [CI] 0.54-1.6). There were no significant differences between groups in any of the other outcomes. CONCLUSIONS: It is unnecessary to delay surgery in order to deliver a preload of fluid. Regardless of the fluid loading strategy, the incidence of maternal hypotension is high. Prophylactic or therapeutic vasopressors may be required in a significant proportion of patients. SN - 1496-8975 UR - https://www.unboundmedicine.com/medline/citation/19859776/Preload_or_coload_for_spinal_anesthesia_for_elective_Cesarean_delivery:_a_meta_analysis_ L2 - https://dx.doi.org/10.1007/s12630-009-9206-7 DB - PRIME DP - Unbound Medicine ER -