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Crystalloid Coload Reduced the Incidence of Hypotension in Spinal Anesthesia for Cesarean Delivery, When Compared to Crystalloid Preload: A Meta-Analysis.
Biomed Res Int 2017; 2017:3462529BR

Abstract

Objective

To determine whether crystalloid infusion just after intrathecal injection (coload) would be better than infusion before anesthesia (preload) for hypotension prophylaxis in spinal anesthesia for cesarean delivery.

Methods

We searched PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and other databases for randomized controlled trials comparing coload of crystalloid with preload in parturients receiving spinal anesthesia for cesarean delivery. Primary outcome was intraoperative incidence of hypotension. Other outcomes were intraoperative need for vasopressors, hemodynamic variables, neonatal outcomes (umbilical artery pH and Apgar scores), and the incidence of maternal nausea and vomiting. We used RevMan 5.2 and STATA 12.0 for the data analyses.

Results

Ten studies with 824 cases were included. The incidence of hypotension was significantly higher in the preload group compared with the coload group (57.8% versus 47.1%, odds ratio [OR] = 1.62, 95% confidence interval [CI] = 1.11-2.37, and P = 0.01). More patients needed intraoperative vasopressors (OR = 1.71, 95% CI = 1.07-2.04, and P = 0.02) when receiving crystalloid preload. In addition, the incidence of nausea and vomiting was higher in the preload group (OR = 3.40, 95% CI = 1.88-6.16, and P < 0.0001). There were no differences in neonatal outcomes between the groups.

Conclusions

For parturients receiving crystalloid loading in spinal anesthesia for cesarean delivery, coload strategy is superior to preload for the prevention of maternal hypotension.

Authors+Show Affiliations

Department of Anesthesiology, First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou, Jiangsu 215006, China.Department of Anesthesiology, First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou, Jiangsu 215006, China.Department of Anesthesiology, First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou, Jiangsu 215006, China.Department of Anesthesiology, First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou, Jiangsu 215006, China.Department of Anesthesiology, First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou, Jiangsu 215006, China.

Pub Type(s)

Journal Article
Meta-Analysis

Language

eng

PubMed ID

29404368

Citation

Ni, Hai-Fang, et al. "Crystalloid Coload Reduced the Incidence of Hypotension in Spinal Anesthesia for Cesarean Delivery, when Compared to Crystalloid Preload: a Meta-Analysis." BioMed Research International, vol. 2017, 2017, p. 3462529.
Ni HF, Liu HY, Zhang J, et al. Crystalloid Coload Reduced the Incidence of Hypotension in Spinal Anesthesia for Cesarean Delivery, When Compared to Crystalloid Preload: A Meta-Analysis. Biomed Res Int. 2017;2017:3462529.
Ni, H. F., Liu, H. Y., Zhang, J., Peng, K., & Ji, F. H. (2017). Crystalloid Coload Reduced the Incidence of Hypotension in Spinal Anesthesia for Cesarean Delivery, When Compared to Crystalloid Preload: A Meta-Analysis. BioMed Research International, 2017, p. 3462529. doi:10.1155/2017/3462529.
Ni HF, et al. Crystalloid Coload Reduced the Incidence of Hypotension in Spinal Anesthesia for Cesarean Delivery, when Compared to Crystalloid Preload: a Meta-Analysis. Biomed Res Int. 2017;2017:3462529. PubMed PMID: 29404368.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Crystalloid Coload Reduced the Incidence of Hypotension in Spinal Anesthesia for Cesarean Delivery, When Compared to Crystalloid Preload: A Meta-Analysis. AU - Ni,Hai-Fang, AU - Liu,Hua-Yue, AU - Zhang,Juan, AU - Peng,Ke, AU - Ji,Fu-Hai, Y1 - 2017/12/17/ PY - 2017/08/02/received PY - 2017/11/07/revised PY - 2017/11/16/accepted PY - 2018/2/7/entrez PY - 2018/2/7/pubmed PY - 2018/8/16/medline SP - 3462529 EP - 3462529 JF - BioMed research international JO - Biomed Res Int VL - 2017 N2 - Objective: To determine whether crystalloid infusion just after intrathecal injection (coload) would be better than infusion before anesthesia (preload) for hypotension prophylaxis in spinal anesthesia for cesarean delivery. Methods: We searched PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and other databases for randomized controlled trials comparing coload of crystalloid with preload in parturients receiving spinal anesthesia for cesarean delivery. Primary outcome was intraoperative incidence of hypotension. Other outcomes were intraoperative need for vasopressors, hemodynamic variables, neonatal outcomes (umbilical artery pH and Apgar scores), and the incidence of maternal nausea and vomiting. We used RevMan 5.2 and STATA 12.0 for the data analyses. Results: Ten studies with 824 cases were included. The incidence of hypotension was significantly higher in the preload group compared with the coload group (57.8% versus 47.1%, odds ratio [OR] = 1.62, 95% confidence interval [CI] = 1.11-2.37, and P = 0.01). More patients needed intraoperative vasopressors (OR = 1.71, 95% CI = 1.07-2.04, and P = 0.02) when receiving crystalloid preload. In addition, the incidence of nausea and vomiting was higher in the preload group (OR = 3.40, 95% CI = 1.88-6.16, and P < 0.0001). There were no differences in neonatal outcomes between the groups. Conclusions: For parturients receiving crystalloid loading in spinal anesthesia for cesarean delivery, coload strategy is superior to preload for the prevention of maternal hypotension. SN - 2314-6141 UR - https://www.unboundmedicine.com/medline/citation/29404368/Crystalloid_Coload_Reduced_the_Incidence_of_Hypotension_in_Spinal_Anesthesia_for_Cesarean_Delivery_When_Compared_to_Crystalloid_Preload:_A_Meta_Analysis_ L2 - https://dx.doi.org/10.1155/2017/3462529 DB - PRIME DP - Unbound Medicine ER -