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Fluid and vasopressor management for Cesarean delivery under spinal anesthesia: continuing professional development.
Can J Anaesth 2012; 59(6):604-19CJ

Abstract

PURPOSE

The purpose of this Continuing Professional Development module is to review the physiology of maternal hypotension induced by spinal anesthesia in pregnant women, and the effects of fluids and vasopressors.

PRINCIPAL FINDINGS

Maternal hypotension induced by spinal anesthesia is caused mainly by peripheral vasodilatation and is not usually associated with a decrease in cardiac output. Although the intravenous administration of fluids helps to increase cardiac output, it does not always prevent maternal hypotension. Three strategies of fluid administrations are equivalent for the prevention of maternal hypotension and a reduced need for vasopressors: (1) colloid preload; (2) colloid coload; and (3) crystalloid coload. Crystalloid preload is not as effective as any of those three strategies. Unlike phenylephrine, ephedrine can cause fetal acidosis. Therefore, phenylephrine is recommended as first line treatment of maternal hypotension. A phenylephrine infusion (25-50 μg x min(-1)) appears to be more effective than phenylephrine boluses to prevent hypotension, and nausea and vomiting. In pre-eclamptic patients, spinal anesthesia produces less hypotension than in normal pregnant women and fluid volumes up to 1,000 mL are usually well tolerated. Therefore mild to moderate intravascular volume loading is recommended, keeping in mind the increased risk for pulmonary edema in this population. In pre-eclamptic patients, hypotension can be treated either with ephedrine or phenylephrine, and phenylephrine infusions are not recommended.

CONCLUSION

A volume loading regimen other than crystalloid preload should be adopted. A phenylephrine infusion during elective Cesarean delivery is beneficial for the mother and safe for the newborn.

Authors+Show Affiliations

Département d'anesthésie, Hôpital Maisonneuve-Rosemont, 5415, boul. l'Assomption, Montreal, QC, H1T 2M4, Canada. loubertch@yahoo.fr

Pub Type(s)

Comparative Study
Journal Article
Review

Language

eng fre

PubMed ID

22528166

Citation

Loubert, Christian. "Fluid and Vasopressor Management for Cesarean Delivery Under Spinal Anesthesia: Continuing Professional Development." Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie, vol. 59, no. 6, 2012, pp. 604-19.
Loubert C. Fluid and vasopressor management for Cesarean delivery under spinal anesthesia: continuing professional development. Can J Anaesth. 2012;59(6):604-19.
Loubert, C. (2012). Fluid and vasopressor management for Cesarean delivery under spinal anesthesia: continuing professional development. Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie, 59(6), pp. 604-19. doi:10.1007/s12630-012-9705-9.
Loubert C. Fluid and Vasopressor Management for Cesarean Delivery Under Spinal Anesthesia: Continuing Professional Development. Can J Anaesth. 2012;59(6):604-19. PubMed PMID: 22528166.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Fluid and vasopressor management for Cesarean delivery under spinal anesthesia: continuing professional development. A1 - Loubert,Christian, Y1 - 2012/04/24/ PY - 2011/11/28/received PY - 2012/03/20/accepted PY - 2012/4/25/entrez PY - 2012/4/25/pubmed PY - 2012/9/19/medline SP - 604 EP - 19 JF - Canadian journal of anaesthesia = Journal canadien d'anesthesie JO - Can J Anaesth VL - 59 IS - 6 N2 - PURPOSE: The purpose of this Continuing Professional Development module is to review the physiology of maternal hypotension induced by spinal anesthesia in pregnant women, and the effects of fluids and vasopressors. PRINCIPAL FINDINGS: Maternal hypotension induced by spinal anesthesia is caused mainly by peripheral vasodilatation and is not usually associated with a decrease in cardiac output. Although the intravenous administration of fluids helps to increase cardiac output, it does not always prevent maternal hypotension. Three strategies of fluid administrations are equivalent for the prevention of maternal hypotension and a reduced need for vasopressors: (1) colloid preload; (2) colloid coload; and (3) crystalloid coload. Crystalloid preload is not as effective as any of those three strategies. Unlike phenylephrine, ephedrine can cause fetal acidosis. Therefore, phenylephrine is recommended as first line treatment of maternal hypotension. A phenylephrine infusion (25-50 μg x min(-1)) appears to be more effective than phenylephrine boluses to prevent hypotension, and nausea and vomiting. In pre-eclamptic patients, spinal anesthesia produces less hypotension than in normal pregnant women and fluid volumes up to 1,000 mL are usually well tolerated. Therefore mild to moderate intravascular volume loading is recommended, keeping in mind the increased risk for pulmonary edema in this population. In pre-eclamptic patients, hypotension can be treated either with ephedrine or phenylephrine, and phenylephrine infusions are not recommended. CONCLUSION: A volume loading regimen other than crystalloid preload should be adopted. A phenylephrine infusion during elective Cesarean delivery is beneficial for the mother and safe for the newborn. SN - 1496-8975 UR - https://www.unboundmedicine.com/medline/citation/22528166/Fluid_and_vasopressor_management_for_Cesarean_delivery_under_spinal_anesthesia:_continuing_professional_development_ L2 - https://dx.doi.org/10.1007/s12630-012-9705-9 DB - PRIME DP - Unbound Medicine ER -