Crystalloid Preload versus Rapid Crystalloid Administration after Induction of Spinal Anaesthesia (Coload) for Elective Caesarean Section

• Published in: Anaesthesia and intensive care Vol. 32; no. 3; pp. 351 - 357
• Main Authors: Dyer, R. A., Farina, Z., Joubert, I. A., Du Toit, P., Meyer, M., Torr, G., Wells, K., James, M. F. M.
• Format: Journal Article
• Language: English
• Published: Edgecliff Anaesthesia and Intensive Care 01.06.2004; Sage Publications Ltd
• Subjects: Anesthesia; Anesthesia, Obstetrical; Anesthesia, Spinal; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Blood Pressure; Cesarean Section; Crystalloid Solutions; Elective Surgical Procedures; Ephedrine - therapeutic use; Female; Humans; Hypotension - drug therapy; Hypotension - prevention & control; Infusions, Intravenous; Isotonic Solutions; Medical sciences; Plasma Substitutes - administration & dosage; Postoperative Care; Postoperative Complications - prevention & control; Pregnancy; Preoperative Care; Vasoconstrictor Agents - therapeutic use; REGIONAL: spinal. SURGERY: caesarean section. FLUIDS: intravenous: crystalloid preload; Anesthesia; ANAESTHESIA; Intravenous administration; Surgery; Comparative study
• ISSN: 0310-057X; 1448-0271
• DOI: 10.1177/0310057X0403200308

Current methods of crystalloid preload administration prior to spinal anaesthesia for elective caesarean section are relatively ineffective in preventing hypotension. This study examined the relevance of the timing of the fluid administered. Fifty women were randomly allocated to receive either 20 ml.kg –1 of crystalloid solution during 20 minutes prior to induction of spinal anaesthesia (preload), or an equivalent volume by rapid infusion immediately after induction (coload). Significantly more patients in the coload group did not require vasopressor therapy pre-delivery (P=0.047). The coload group required a lower median dose (P=0.03) and a lower median number (P=0.04) of ephedrine doses for the treatment of maternal hypotension pre-delivery. There was no between-group difference in either the total cumulative dose, or in the total number of doses of ephedrine. Neonatal outcomes among the two groups were similar. Rapid crystalloid administration after, rather than over 20 minutes before the induction of spinal anaesthesia for elective caesarean section, may be advantageous in terms of managing maternal blood pressure prior to delivery.