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Comparison between colloid preload and crystalloid co-load in cesarean section under spinal anesthesia: a randomized controlled trial.
Int J Obstet Anesth 2014; 23(4):317-23IJ

Abstract

BACKGROUND

Hypotension is a common problem during spinal anesthesia for cesarean delivery. Intravenous fluid loading is used to correct preoperative dehydration and reduce the incidence and severity of hypotension. Different fluid regimens have been studied but colloid preload and crystalloid co-load have not been compared.

METHODS

In this randomized double-blind study, 210 patients scheduled for elective cesarean section under spinal anesthesia were randomly allocated to receive either 6% hydroxyethyl starch 130/0.4 500 mL before spinal anesthesia (colloid preload) or Ringer's acetate solution 1000 mL administered rapidly starting with intrathecal injection (crystalloid co-load). Maternal hypotension (systolic blood pressure <80% of baseline or <90 mmHg) and severe hypotension (systolic blood pressure <80 mmHg) were treated with 5 and 10mg ephedrine boluses, respectively. The primary outcome was the incidence of hypotension. Secondary outcomes included the incidence of severe hypotension, total ephedrine dose, nausea and vomiting and neonatal outcome assessed by Apgar scores and umbilical artery blood gas analysis.

RESULTS

Data analysis was performed on 205 patients; 103 in the colloid preload group and 102 in the crystalloid co-load group. There were no significant differences in the incidence of hypotension (52.4% vs. 42.2%; P=0.18) or severe hypotension (15.5% vs. 9.8%; P=0.31) between colloid preload and crystalloid co-load groups, respectively. The median [range] ephedrine dose was 5 [0-45]mg in the colloid preload group and 0 [0-35]mg in the crystalloid co-load group (P=0.065). There were no significant differences in maternal nausea or vomiting or neonatal outcomes between groups.

CONCLUSION

The use of 1000 mL crystalloid co-load has similar effect to 500 mL colloid preload in reducing the incidence of hypotension after spinal anesthesia for elective cesarean delivery. Neither technique can totally prevent hypotension and should be combined with vasopressor use.

Authors+Show Affiliations

Department of Anesthesia and Surgical Intensive Care, Mansoura University Hospitals, Mansoura, Egypt. Electronic address: m2tawfik@hotmail.com.Department of Anesthesia and Surgical Intensive Care, Mansoura University Hospitals, Mansoura, Egypt.Department of Anesthesia and Surgical Intensive Care, Mansoura University Hospitals, Mansoura, Egypt.Department of Anesthesia and Surgical Intensive Care, Mansoura University Hospitals, Mansoura, Egypt.Department of Anesthesia and Surgical Intensive Care, Mansoura University Hospitals, Mansoura, Egypt.Department of Obstetrics and Gynecology, Mansoura University Hospitals, Mansoura, Egypt.Department of Anesthesia and Surgical Intensive Care, Mansoura University Hospitals, Mansoura, Egypt.Department of Anesthesia and Surgical Intensive Care, Mansoura University Hospitals, Mansoura, Egypt.

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

25281437

Citation

Tawfik, M M., et al. "Comparison Between Colloid Preload and Crystalloid Co-load in Cesarean Section Under Spinal Anesthesia: a Randomized Controlled Trial." International Journal of Obstetric Anesthesia, vol. 23, no. 4, 2014, pp. 317-23.
Tawfik MM, Hayes SM, Jacoub FY, et al. Comparison between colloid preload and crystalloid co-load in cesarean section under spinal anesthesia: a randomized controlled trial. Int J Obstet Anesth. 2014;23(4):317-23.
Tawfik, M. M., Hayes, S. M., Jacoub, F. Y., Badran, B. A., Gohar, F. M., Shabana, A. M., ... Emara, M. M. (2014). Comparison between colloid preload and crystalloid co-load in cesarean section under spinal anesthesia: a randomized controlled trial. International Journal of Obstetric Anesthesia, 23(4), pp. 317-23. doi:10.1016/j.ijoa.2014.06.006.
Tawfik MM, et al. Comparison Between Colloid Preload and Crystalloid Co-load in Cesarean Section Under Spinal Anesthesia: a Randomized Controlled Trial. Int J Obstet Anesth. 2014;23(4):317-23. PubMed PMID: 25281437.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison between colloid preload and crystalloid co-load in cesarean section under spinal anesthesia: a randomized controlled trial. AU - Tawfik,M M, AU - Hayes,S M, AU - Jacoub,F Y, AU - Badran,B A, AU - Gohar,F M, AU - Shabana,A M, AU - Abdelkhalek,M, AU - Emara,M M, Y1 - 2014/06/30/ PY - 2014/03/01/received PY - 2014/06/07/revised PY - 2014/06/22/accepted PY - 2014/10/5/entrez PY - 2014/10/5/pubmed PY - 2015/7/30/medline KW - Cesarean section KW - Co-load KW - Hypotension KW - Intravenous fluids KW - Preload KW - Spinal anesthesia SP - 317 EP - 23 JF - International journal of obstetric anesthesia JO - Int J Obstet Anesth VL - 23 IS - 4 N2 - BACKGROUND: Hypotension is a common problem during spinal anesthesia for cesarean delivery. Intravenous fluid loading is used to correct preoperative dehydration and reduce the incidence and severity of hypotension. Different fluid regimens have been studied but colloid preload and crystalloid co-load have not been compared. METHODS: In this randomized double-blind study, 210 patients scheduled for elective cesarean section under spinal anesthesia were randomly allocated to receive either 6% hydroxyethyl starch 130/0.4 500 mL before spinal anesthesia (colloid preload) or Ringer's acetate solution 1000 mL administered rapidly starting with intrathecal injection (crystalloid co-load). Maternal hypotension (systolic blood pressure <80% of baseline or <90 mmHg) and severe hypotension (systolic blood pressure <80 mmHg) were treated with 5 and 10mg ephedrine boluses, respectively. The primary outcome was the incidence of hypotension. Secondary outcomes included the incidence of severe hypotension, total ephedrine dose, nausea and vomiting and neonatal outcome assessed by Apgar scores and umbilical artery blood gas analysis. RESULTS: Data analysis was performed on 205 patients; 103 in the colloid preload group and 102 in the crystalloid co-load group. There were no significant differences in the incidence of hypotension (52.4% vs. 42.2%; P=0.18) or severe hypotension (15.5% vs. 9.8%; P=0.31) between colloid preload and crystalloid co-load groups, respectively. The median [range] ephedrine dose was 5 [0-45]mg in the colloid preload group and 0 [0-35]mg in the crystalloid co-load group (P=0.065). There were no significant differences in maternal nausea or vomiting or neonatal outcomes between groups. CONCLUSION: The use of 1000 mL crystalloid co-load has similar effect to 500 mL colloid preload in reducing the incidence of hypotension after spinal anesthesia for elective cesarean delivery. Neither technique can totally prevent hypotension and should be combined with vasopressor use. SN - 1532-3374 UR - https://www.unboundmedicine.com/medline/citation/25281437/Comparison_between_colloid_preload_and_crystalloid_co_load_in_cesarean_section_under_spinal_anesthesia:_a_randomized_controlled_trial_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0959-289X(14)00104-6 DB - PRIME DP - Unbound Medicine ER -