Skip to main content
SpringerLink
Log in

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

  • Published:
Journal of Clinical Monitoring and Computing Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Marx GF, Cosmi EV, Wollman SB (1969) Biochemical status and clinical condition of mother and infant at Cesarean section. Anesth Analg 48:986–994

    Article  CAS  PubMed  Google Scholar 

  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 79:262–269

    Article  CAS  PubMed  Google Scholar 

  3. Rout CC, Rocke DA (1999) Spinal hypotension associated with Cesarean section: Will preload ever work?. Anesthesiology 91:1565–1567

    Article  CAS  PubMed  Google Scholar 

  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 68:394–397

    Article  Google Scholar 

  5. Jackson R, Reid JA, Thorburn J (1995) Volume preloading is not essential to prevent spinal-induced hypotension at caesarean section. Br J Anaesth 75:262–265

    CAS  PubMed  Google Scholar 

  6. Kamenik M, Paver-Erzen V (2001) The effects of lactated Ringer’s solution infusion on cardiac output changes after spinal anesthesia. Anesth Analg 92:710–714

    Article  CAS  PubMed  Google Scholar 

  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 63:217–219

    Article  CAS  PubMed  Google Scholar 

  8. Hahn RG, Edsberg L, Sjostrand F (2003) Volume kinetic analysis of fluid shifts accompanying intravenous infusions of glucose solution Cell Biochem Biophys 39:211–222

    Article  CAS  PubMed  Google Scholar 

  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 32:351–357

    CAS  PubMed  Google Scholar 

  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 92:997–1005

    Article  CAS  PubMed  Google Scholar 

  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 83:299–303

    Article  CAS  PubMed  Google Scholar 

  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 3:20–24

    Article  CAS  PubMed  Google Scholar 

  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 76:731–733

    CAS  PubMed  Google Scholar 

  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 37:55–59

    CAS  PubMed  Google Scholar 

  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 83:475–477

    CAS  PubMed  Google Scholar 

  16. Suidan JS, Wasserman JF, Young BK (1984) Placental contribution to lactate production by the human fetoplacental unit. Am J Perinatol 1:306–309

    Article  CAS  PubMed  Google Scholar 

  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. 173:1416–1422

    Article  CAS  PubMed  Google Scholar 

  18. Datta S, Ostheimer GW, Weiss JB, Brown WU Jr, Alper MH (1981) Neonatal effect of prolonged anesthetic induction for cesarean section. Obstet Gynecol 58:331–335

    CAS  PubMed  Google Scholar 

  19. Crawford JS, Burton M, Davies P (1973) Anaesthesia for section: Further refinements of a technique. Br J Anaesth 45:726–732

    Article  CAS  PubMed  Google Scholar 

  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 97:1582–1590

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

This study was supported by a Grant-in- aid for Scientific Research from the Ministry of Education, Science, Sports, and Culture of Japan to K.N. (#17390425 and #17659483).

Author information

Authors and Affiliations

  1. Department of Anesthesiology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi City, 371-8511, Japan

    Koichi Nishikawa MD, PhD, Naho Yokoyama MD, Shigeru Saito MD, PhD & Fumio Goto MD, PhD

Authors
  1. Koichi Nishikawa MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Naho Yokoyama MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shigeru Saito MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Fumio Goto MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Koichi Nishikawa MD, PhD.

Additional information

Nishikawa K, Yokoyama N, Saito S, Goto F. Comparison of effects of rapid colloid loading before and after spinal anesthesia on maternal hemodynamics and neonatal outcomes in cesarean section.

A part of the present study was presented at the Annual Meeting of the American Society of Anesthesiologists, October 23–27, 2004 in Las Vegas, Nevada, USA.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Nishikawa, K., Yokoyama, N., Saito, S. et al. Comparison of effects of rapid colloid loading before and after spinal anesthesia on maternal hemodynamics and neonatal outcomes in cesarean section. J Clin Monit Comput 21, 125–129 (2007). https://doi.org/10.1007/s10877-006-9066-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10877-006-9066-4

Keywords

Search

Navigation