Crystalloid preload versus crystalloid coload for parturients undergoing cesarean section under spinal anesthesia

Jacob, Jewel J; Williams, Aparna; Verghese, Mary; Afzal, Lalita

doi:10.4103/2249-4472.99309

Cited by 13 publications

(16 citation statements)

References 15 publications

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“…The flow diagram is shown in Figure 1 . Ten trials [ 11 , 12 , 14 – 21 ] with 824 patients were eligible for inclusion into this study. The characteristics are summarized in Table 1 .…”

Section: Resultsmentioning

confidence: 99%

“…In these studies, hypotension was defined as a 20% decrease from baseline in MAP or SBP, or SBP < 90 mmHg. Seven studies [ 11 , 12 , 15 – 18 , 21 ] used ephedrine to treat intraoperative hypotension, two studies [ 14 , 19 ] used ephedrine or phenylephrine, and mephentermine was selected in one study [ 20 ]. Seven studies [ 11 , 12 , 14 , 16 , 17 , 19 , 20 ] used vasopressors when patients developed hypotension, while one study [ 18 ] combined crystalloid boluses and ephedrine.…”

Section: Resultsmentioning

confidence: 99%

“…Seven studies [ 11 , 12 , 14 , 16 , 17 , 19 , 20 ] used vasopressors when patients developed hypotension, while one study [ 18 ] combined crystalloid boluses and ephedrine. Nine studies [ 11 , 12 , 14 – 18 , 20 , 21 ] recorded the number of patients with hypotension throughout the surgery, and one study [ 19 ] recorded hypotension at 3 and 5 min after anesthesia induction.…”

Section: Resultsmentioning

confidence: 99%

“…Pooled data from ten studies [ 11 , 12 , 14 – 21 ] showed that patients in the crystalloid preload group had more hypotensive episodes than those in the coload group (57.8% versus 47.1%, OR = 1.62, 95% CI = 1.11–2.37, and P = 0.01) ( Figure 2(a) ). Sensitivity analysis reflected that these findings were robust ( Figure 2(b) ), with pooled ORs ranging from 1.49 (95% CI = 1.01–1.29) to 1.80 (95% CI = 2.18–2.60).…”

Section: Resultsmentioning

confidence: 99%

“…Intraoperative HR, SBP, and MAP are shown in Figure 5 . Four studies [ 12 , 15 , 16 , 21 ] reporting on HR during 60 min after spinal anesthesia showed a higher HR in the preload group (MD = 2.18 beats/min, 95% CI = 0.02–4.35, and P = 0.05). Five studies [ 12 , 15 , 16 , 20 , 21 ] on SBP found no significant difference between the groups.…”

Section: Resultsmentioning

confidence: 99%

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Crystalloid Coload Reduced the Incidence of Hypotension in Spinal Anesthesia for Cesarean Delivery, When Compared to Crystalloid Preload: A Meta-Analysis

Liu

Zhang

et al. 2017

BioMed Research International

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Objective To determine whether crystalloid infusion just after intrathecal injection (coload) would be better than infusion before anesthesia (preload) for hypotension prophylaxis in spinal anesthesia for cesarean delivery. Methods We searched PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and other databases for randomized controlled trials comparing coload of crystalloid with preload in parturients receiving spinal anesthesia for cesarean delivery. Primary outcome was intraoperative incidence of hypotension. Other outcomes were intraoperative need for vasopressors, hemodynamic variables, neonatal outcomes (umbilical artery pH and Apgar scores), and the incidence of maternal nausea and vomiting. We used RevMan 5.2 and STATA 12.0 for the data analyses. Results Ten studies with 824 cases were included. The incidence of hypotension was significantly higher in the preload group compared with the coload group (57.8% versus 47.1%, odds ratio [OR] = 1.62, 95% confidence interval [CI] = 1.11–2.37, and P = 0.01). More patients needed intraoperative vasopressors (OR = 1.71, 95% CI = 1.07–2.04, and P = 0.02) when receiving crystalloid preload. In addition, the incidence of nausea and vomiting was higher in the preload group (OR = 3.40, 95% CI = 1.88–6.16, and P < 0.0001). There were no differences in neonatal outcomes between the groups. Conclusions For parturients receiving crystalloid loading in spinal anesthesia for cesarean delivery, coload strategy is superior to preload for the prevention of maternal hypotension.

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“…The flow diagram is shown in Figure 1 . Ten trials [ 11 , 12 , 14 – 21 ] with 824 patients were eligible for inclusion into this study. The characteristics are summarized in Table 1 .…”

Section: Resultsmentioning

confidence: 99%