Comparison of effects of rapid colloid loading before and after spinal anesthesia on maternal hemodynamics and neonatal outcomes in cesarean section

  • Koichi Nishikawa
  • Naho Yokoyama
  • Shigeru Saito
  • Fumio Goto
Article

Abstract

Background

The effects of colloid loading after spinal anesthesia on hemodynamics in parturients during cesarean section have not been fully understood. This study tested the hypothesis that colloid loading after spinal blockade can reduce hypotension compared with preloading, and affect neonatal outcomes.

Methods

A prospective, randomized, double-blinded study was performed in 54 healthy parturients (ASA I or II) undergoing elective cesarean section. Patients were randomly allocated into one of three groups to receive rapid infusion of 6% hydroxyethylstarch (HES) (70 kDa/0.5) before spinal anesthesia (15 ml·kg−1, HES preload group, n = 18), or rapid infusion of HES after induction of spinal anesthesia (15 ml·kg−1, HES coload group, n = 18), or no rapid infusion (control, n = 18). The incidence of hypotension, and the amount of ephedrine used to treat hypotension was compared. Neonatal outcomes were also assessed by pH, base excess, lactate concentration, and Apgar scores.

Results

The incidence of hypotension was significantly lower in HES preload and HES coload groups than control group (P < 0.01). Although systolic blood pressure decreased after spinal blockade in all groups, the lowest SBP after spinal blockade until delivery was significantly higher in fluid loading groups than control (P < 0.001). Similarly, total dose of ephedrine to treat hypotension was lower in fluid loading groups (P < 0.001). Umbilical cord pH, umbilical lactate concentration, and the incidence of neonates with Apgar score <7 were similar.

Conclusion

Colloid loading after induction of spinal anesthesia was similarly effective in reducing hypo-tension compared with preloading in cesarean section.

Keywords

Ringer’s solution fetal acidosis colloid lactate concentration volume coload 

References

  1. 1.
    Marx GF, Cosmi EV, Wollman SB (1969) Biochemical status and clinical condition of mother and infant at Cesarean section. Anesth Analg 48:986–994CrossRefPubMedGoogle Scholar
  2. 2.
    Rout CC, Rocke DA, Levin J, Gouws E, Reddy D (1993) A reevaluation of the role of crystalloid preload in the prevention of hypotension associated with spinal anesthesia for elective Cesarean section. Anesthesiology 79:262–269CrossRefPubMedGoogle Scholar
  3. 3.
    Rout CC, Rocke DA (1999) Spinal hypotension associated with Cesarean section: Will preload ever work?. Anesthesiology 91:1565–1567CrossRefPubMedGoogle Scholar
  4. 4.
    Route CC, Akoojee SS, Roche DA, Gouws E (1992) Rapid administration of crystalloid preload does not decrease the incidence of hypotension after spinal anesthesia for elective caesarean section. Br J Anaesth 68:394–397CrossRefGoogle Scholar
  5. 5.
    Jackson R, Reid JA, Thorburn J (1995) Volume preloading is not essential to prevent spinal-induced hypotension at caesarean section. Br J Anaesth 75:262–265PubMedGoogle Scholar
  6. 6.
    Kamenik M, Paver-Erzen V (2001) The effects of lactated Ringer’s solution infusion on cardiac output changes after spinal anesthesia. Anesth Analg 92:710–714CrossRefPubMedGoogle Scholar
  7. 7.
    Hughes SC, Ward MG, Levinson G, Shnider SM, Wright RG, Gruenke LD, Craig JC (1985) Placental transfer of ephedrine does not affect neonatal outcome. Anesthesiology 63:217–219CrossRefPubMedGoogle Scholar
  8. 8.
    Hahn RG, Edsberg L, Sjostrand F (2003) Volume kinetic analysis of fluid shifts accompanying intravenous infusions of glucose solution Cell Biochem Biophys 39:211–222CrossRefPubMedGoogle Scholar
  9. 9.
    Dyer RA, Farina Z, Joubert IA, Du Toit P, Meyer M, Torr G, Wells K, James MF (2004) Crystalloid preload versus rapid crystalloid administration after induction of spinal anaesthesia (co load) for elective caesarean section. Anaesth Intensive Care 32:351–357PubMedGoogle Scholar
  10. 10.
    Morgan PJ, Halpern SH, Tarshis J (2001) The effects of an increase of central blood volume before spinal anesthesia for cesarean delivery: A qualitative systematic review. Anesth Analg 92:997–1005CrossRefPubMedGoogle Scholar
  11. 11.
    Park GE, Hauch MA, Curlin F, Datta S, Bader AM (1996) The effects of varying volumes of crystalloid administration before cesarean delivery on maternal hemodynamics and colloid osmotic pressure. Anesth Analg 83:299–303CrossRefPubMedGoogle Scholar
  12. 12.
    Olsen KS, Feilberg VL, Hansen CL, Rudkjobing O, Pedersen T, Kyst A (1994) Prevention of hypotension during spinal anaesthesia for caesarean section. Int J Obstet Anesth 3:20–24CrossRefPubMedGoogle Scholar
  13. 13.
    Vercauteren MP, Hoffmann V, Coppejans HC, Van Steenberge AL, Adriaensen HA (1996) Hydroxyethylstarch compared with modified gelatin as volume preload before spinal anaesthesia for Caesarean section. Br J Anaesth 76:731–733PubMedGoogle Scholar
  14. 14.
    Lin CS, Lin TY, Huang CH, Lin YH, Lin CR, Chan WH, Tsai SK (1999) Prevention of hypotension after spinal anesthesia for cesarean section: Dextran 40 versus lactated Ringer’s solution. Acta Anaesthesiol Sin 37:55–59PubMedGoogle Scholar
  15. 15.
    French GW, White JB, Howell SJ, Popat M (1999) Comparison of pentastarch and Hartmann’s solution for volume preloading in spinal anaesthesia for elective caesarean section. Br J Anaesth 83:475–477PubMedGoogle Scholar
  16. 16.
    Suidan JS, Wasserman JF, Young BK (1984) Placental contribution to lactate production by the human fetoplacental unit. Am J Perinatol 1:306–309CrossRefPubMedGoogle Scholar
  17. 17.
    Westgren M, Divon M, Horal M, Ingemarsson I, Kublickas M, Shimojo N, Nordstrom L (1995) Routine measurements of umbilical artery lactate levels in the prediction of perinatal outcome. Am J Obstet Gynecol. 173:1416–1422CrossRefPubMedGoogle Scholar
  18. 18.
    Datta S, Ostheimer GW, Weiss JB, Brown WU Jr, Alper MH (1981) Neonatal effect of prolonged anesthetic induction for cesarean section. Obstet Gynecol 58:331–335PubMedGoogle Scholar
  19. 19.
    Crawford JS, Burton M, Davies P (1973) Anaesthesia for section: Further refinements of a technique. Br J Anaesth 45:726–732CrossRefPubMedGoogle Scholar
  20. 20.
    Cooper DW, Carpenter M, Mowbray P, Desira WR, Ryall DM, Kokri MS (2002) Fetal and maternal effects of phenylephrine and ephedrine during spinal anesthesia for cesarean delivery. Anesthesiology 97:1582–1590CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2007

Authors and Affiliations

  • Koichi Nishikawa
    • 1
  • Naho Yokoyama
    • 1
  • Shigeru Saito
    • 1
  • Fumio Goto
    • 1
  1. 1.Department of AnesthesiologyGunma University Graduate School of MedicineMaebashi CityJapan

Personalised recommendations