Abstract
BackgroundProphylactic fluid preloading before spinal anesthesia has been a routine procedure to prevent maternal hypotension during cesarean delivery. Unlike colloid, timing of infusion of crystalloid may be important because of its short stay in intravascular space. We hypothesized that crystalloid loading just after intrathecal injection compared to preload would be more effective in preventing maternal hypotension.MethodsIn this prospective controlled study, sixty parturients were randomized to receive 15 ml/kg of crystalloid before (preload group) or after (coload group) intrathecal drug injection for spinal anesthesia. Hypotension was defined if systolic arterial pressure decreased below 80% of baseline and ephedrine was administered to treat hypotension. The incidence of hypotension and the total dose of ephedrine were checked. Blood pressure, heart rate and nausea before childbirth were assessed. Neonatal outcomes were evaluated with Apgar scores and umbilical blood gas analysis.ResultsThe incidence of hypotension was lower in the coload group compared to the preload group (53% vs. 83%, P = 0.026). The blood pressure showed the bigger drop during spinal anesthesia in the preload group (34 ± 13 vs. 25 ± 10 mmHg, P = 0.002) and smaller dose of ephedrine was required in the coload group (7.5 [0–30] vs. 15 [0–40] mg, P = 0.015). The incidence of nausea was also lower in the coload group (27% vs. 60%, P = 0.019). Neonatal outcome measures were comparable between two groups.ConclusionsIn case of using crystalloids for cesarean delivery, coload is more effective than preload for the prevention of maternal hypotension after spinal anesthesia.Trial registrationClinical Research Information Service KCT0000324 (Jan 12th, 2012)
Highlights
Prophylactic fluid preloading before spinal anesthesia has been a routine procedure to prevent maternal hypotension during cesarean delivery
The incidence of hypotension was significantly lower in the coload group compared to the preload group, that is, more parturients in the preload group needed treatment with ephedrine (83.3 % vs. 53.3%, P = 0.026)
This study demonstrated that when administering crystalloids for prevention of maternal hypotension after spinal anesthesia for cesarean delivery, coload is more efficient than preload, that is, administering crystalloids at the actual time of intravascular volume deficit is more efficient than prophylactic administration
Summary
Prophylactic fluid preloading before spinal anesthesia has been a routine procedure to prevent maternal hypotension during cesarean delivery. We hypothesized that crystalloid loading just after intrathecal injection compared to preload would be more effective in preventing maternal hypotension. Maternal hypotension becomes intensified by a deficit of intravascular volume adding to sympathetic blockade during spinal anesthesia. Pre-hydration of fluids was recommended for the prevention of hypotension after spinal anesthesia. The efficacy of preload has been questioned and there were studies to evaluate the preventive effect of preloading of fluid comparing coload, that is, hydration at the time of actual block during cesarean delivery. Some studies [6,7] even found that prehydration using crystalloids had poor efficacy for prevention of hypotension during cesarean delivery. The timing of infusion may be the main key to prevent hypotension because the volume expanding effect is maximal at the time of administration
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