A Reevaluation of the Role of Crystalloid Preload in the Prevention of Hypotension Associated with Spinal Anesthesia for Elective Cesarean Section

Rout, C C; Rocke, D. A.; Levin, Jonathan M.; Gouws, Eleanor; Reddy, Daniel J.

doi:10.1097/00000542-199308000-00011

Cited by 328 publications

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“…This study showed a decrease in maternal heart rate after induction of spinal anaesthesia, in the crystalloid as well as colloid group. Mean maternal heart rate tended to decrease during spinal anaesthesia similarly in both the groups, which was similar to the observation by earlier studies 29,59 .…”

Section: Discussionsupporting

confidence: 91%

Comparison of Hetastarch and Hartman’s Solution for Volume Preloading For Elective Caesarian Section- A Tertiary Care Teaching Centre Experience

S¹

2017

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Section: Discussionsupporting

confidence: 91%

Comparison of Hetastarch and Hartman’s Solution for Volume Preloading For Elective Caesarian Section- A Tertiary Care Teaching Centre Experience

S¹

2017

jmscr

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“…The universal practice of employing a 15°left lateral tilt using an obstetric wedge under the right hip [6] or tilting the table leftwards [7] might help to decrease the degree of aortocaval compression but does not guarantee its absence [8]. Maximum displacement of the uterus is best achieved by mechanical displacers.…”

Section: Discussionmentioning

confidence: 99%

“…The relative hypovolaemia caused by the combination of aortocaval compression and subarachnoid block may lead to placental insufficiency. The incidence of hypotension seems to be unexpectedly high despite preloading with crystalloids (47.4-83%) [1,2] or colloids (17-38%) [3,4] and the use of prophylactic vasoconstrictors (35-80%) [5].The universal practice of employing a 15°left lateral tilt using an obstetric wedge under the right hip [6] or tilting the table leftwards [7] might help to decrease the degree of aortocaval compression but does not guarantee its absence [8]. Maximum displacement of the uterus is best achieved by mechanical displacers.…”

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confidence: 99%

Manual displacement of the uterus during Caesarean section

et al. 2007

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SummaryNinety ASA 1 and 2 pregnant women with term singleton pregnancies and no maternal and fetal complications, scheduled for elective or emergency Caesarean section, were randomly allocated to group LT (15°left lateral table tilt, n = 45) and group MD (leftward manual displacement, n = 45). Subarachnoid block was established with a 25-gauge spinal needle at the L3-L4 interspace using 1.5 ml of 0.5% hyperbaric bupivacaine. A median sensory level of T6 was observed in both groups but the incidence of hypotension was markedly lower in group MD when compared to group LT (4.4% vs 40%; p < 0.001) with a significant reduction in mean (SD) ephedrine requirement (6 (0) vs 11.3 (4.9) mg; p < 0.001). The mean (SD) fall in systolic blood pressure was 28.8 (7.3) mmHg in group LT and 20 (12.7) mmHg in group MD. The time to maximum fall in systolic blood pressure was similar in both groups (4.5 min). We conclude that manual displacement of the uterus effectively reduces the incidence of hypotension and ephedrine requirements when compared to 15°left lateral table tilt in parturients undergoing Caesarean section. Supine hypotension that develops in pregnant women near term has been attributed to aortocaval compression by the enlarged gravid uterus, which decreases venous return to the heart. Use of subarachnoid block compounds the problem of hypotension in the supine parturient by causing vasodilation and venous pooling of blood in the lower limbs. The relative hypovolaemia caused by the combination of aortocaval compression and subarachnoid block may lead to placental insufficiency. The incidence of hypotension seems to be unexpectedly high despite preloading with crystalloids (47.4-83%) [1,2] or colloids (17-38%) [3,4] and the use of prophylactic vasoconstrictors (35-80%) [5].The universal practice of employing a 15°left lateral tilt using an obstetric wedge under the right hip [6] or tilting the table leftwards [7] might help to decrease the degree of aortocaval compression but does not guarantee its absence [8]. Maximum displacement of the uterus is best achieved by mechanical displacers. Hypotension was witnessed in only one out of the 300 patients by Colon-Morales [9] in his series. A similar magnitude of uterine displacement can be accomplished by the anaesthetist placing their right hand beneath the right costal margin to attain a maximum fundal push towards the left until the baby is delivered. Mechanical displacement of the gravid uterus seems to be a more logical and effective approach to managing hypotension as it helps in directly relieving the aortocaval compression by dislodging the gravid uterus. This study was therefore designed to evaluate the role of manual leftward uterine displacement in preventing hypotension for parturients undergoing lower segment Caesarean section (LSCS) under subarachnoid block. MethodsNinety pregnant women, ASA physical status 1 or 2, with full term singleton pregnancies and scheduled to undergo elective or emergency LSCS under subarachnoid block were included in the study followin...

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“…29,30 In a nonblinded study that used a sequential analysis design, a preload of 20 mL·kg -1 lactated Ringer's solution reduced the incidence of hypotension from 71% to 55% but did not affect neonatal outcome or ephedrine requirement. 29 After this, a randomized blinded trial showed no beneficial effect of 1000 mL crystalloid. 30 In this systematic review, only one trial compared prophylactic ephedrine infusion with fluid preloading.…”

Section: Standard Base Excessmentioning

confidence: 99%

Prophylactic ephedrine prevents hypotension during spinal anesthesia for Cesarean delivery but does not improve neonatal outcome: a quantitative systematic review

Lee

Kee

Gin

2002

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : The objective of this systematic review was to assess the effectiveness and safety of ephedrine compared with control when given prophylactically to prevent hypotension during spinal anesthesia for Cesarean delivery.S So ou ur rc ce e: : Randomized, controlled trials obtained through MEDLINE, EMBASE, the Cochrane Controlled Trials Registry, contact with leading experts, and a reference list of published articles were analyzed. The following keywords were utilized: spinal anesthesia, hypotension, Cesarean section, pregnancy complications, pregnancy outcome, fetal outcome, neonatal outcome, umbilical blood cord gases, vasopressor and ephedrine. Clinical trials were considered if they compared prophylactic ephedrine, given by any dose or route, vs control. P Pr ri in nc ci ip pa al l f fi in nd di in ng gs s: : The 14 clinical trials identified included data from a total of 641 patients. Ephedrine was more effective than control for preventing hypotension (relative risk [RR], 0.73; 95% confidence interval [CI], 0.63 to 0.86). Most importantly, there was no difference in the risk of fetal acidosis, defined as umbilical arterial pH < 7.2 (RR, 1.36; 95% CI, 0.55 to 3.35) or the incidence of low Apgar scores (< 7 or < 8) at one minute (RR, 0.77; 95% CI, 0.29 to 2.06) and five minutes (RR, 0.72; 95% CI, 0.24 to 2.19).C Co on nc cl lu us si io on ns s: : Prophylactic ephedrine is more effective than control for preventing hypotension during spinal anesthesia for elective Cesarean delivery but a clinically relevant positive effect on neonatal outcome was not observed. Therefore, the routine use of prophylactic ephedrine to prevent any adverse effects of maternal hypotension following spinal anesthesia for Cesarean delivery is not supported by the current systematic review.Objectif : Évaluer l'efficacité et l'innocuité de l'éphédrine, comparée à un témoin, administrée de manière prophylactique pour prévenir l'hypotension pendant la rachianesthésie lors de l'accouchement par Césarienne. (RR,1,36 ; IC de 95 %, 0,55 à 3,35) ou l'incidence d'indice d'Apgar < 7 ou < 8 à une minute (RR, 0,77 ; IC 95 %, 0,29 à 2,06) et à cinq minutes (RR, 0,72 ; IC 95 %, 0,24 à 2,19 Source : Nous avons analysé des essais randomisés et contrôlés obtenus de MEDLINE, EMBASE, l'Index Cochrane des essais randomisés et contrôlés, personnes-ressources autorisées et une liste de références d'articles publiés. Les mots clés ont été

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A Reevaluation of the Role of Crystalloid Preload in the Prevention of Hypotension Associated with Spinal Anesthesia for Elective Cesarean Section

Cited by 328 publications

References 0 publications

Comparison of Hetastarch and Hartman’s Solution for Volume Preloading For Elective Caesarian Section- A Tertiary Care Teaching Centre Experience

Comparison of Hetastarch and Hartman’s Solution for Volume Preloading For Elective Caesarian Section- A Tertiary Care Teaching Centre Experience

Manual displacement of the uterus during Caesarean section

Prophylactic ephedrine prevents hypotension during spinal anesthesia for Cesarean delivery but does not improve neonatal outcome: a quantitative systematic review

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