Maternal Cardiac Output Changes After Crystalloid or Colloid Coload Following Spinal Anesthesia for Elective Cesarean Delivery

McDonald, Sarah; Fernando, Roshan; Ashpole, K.; Columb, Malachy O.

doi:10.1213/ane.0b013e31822c0f08

Cited by 83 publications

(70 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…35 To date, only one published study has compared co-loading with 1,000 mL of hydroxyethyl starch and co-loading with an equivalent volume of crystalloid in parturients who also received a phenylephrine infusion. 19 The authors did not report any difference between groups in terms of either hemodynamic or neonatal data. The investigators noted a transient increase in cardiac output at five and ten minutes following spinal anesthesia in patients receiving crystalloids and colloids, respectively.…”

Section: Intravascular Volume Loading Strategiesmentioning

confidence: 91%

“…However, maintenance of cardiac output during onset of sympathetic blockade depends, in part, on both the type of fluid given (crystalloids or colloids) and the timing of its administration. 11,18,19 The anesthesiologist can choose between four fluid loading regimens: two types of fluid are available (colloids or crystalloids) and each can be given either before the spinal anesthetic (preload), or immediately after (co-load) ( Table 2). 20 Crystalloid preload (regimen I)…”

Section: Intravascular Volume Loading Strategiesmentioning

confidence: 99%

“…En effet, les études ont démontré qu'un remplissage vasculaire avant l'administration de l'anesthésie rachidienne augmente le débit cardiaque. 11,18,19 Cependant, le maintien de cet effet lors de l'installation du bloc sympathique dépend en partie de la combinaison du type de liquide administré (cristalloïde ou colloïde) et du moment de son administration. Quatre stratégies de remplissage vasculaire sont à la disposition de l'anesthésiologiste: il a le choix du type de liquide (colloïdes ou cristalloïdes) et du moment de l'administration, soit avant l'anesthésie rachidienne (préremplissage) ou immédiatement après (coremplissage) (Tableau 2).…”

Section: Les Stratégies De Remplissage Vasculaireunclassified

“…35 Une seule étude jusqu'à présent a comparé le coremplissage avec 1,000 mL d'hydroxyéthylamidon à un coremplissage avec un volume équivalent de cristalloïdes chez des parturientes qui recevaient par ailleurs une perfusion de phenyléphrine. 19 Les auteurs n'ont noté aucune différence entre les groupes ni sur le plan hémodynamique ni sur le plan néonatal. Les investigateurs ont remarqué une augmentation transitoire du débit cardiaque dans les cinq et dix premières minutes suivant la rachianesthésie chez les sujets recevant des cristalloïdes et des colloïdes, respectivement.…”

Section: Le Coremplissage Liquidienunclassified

See 3 more Smart Citations

Fluid and vasopressor management for Cesarean delivery under spinal anesthesia: Continuing Professional Development

Loubert

2012

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

Purpose The purpose of this Continuing Professional Development module is to review the physiology of maternal hypotension induced by spinal anesthesia in pregnant women, and the effects of fluids and vasopressors. Principal findings Maternal hypotension induced by spinal anesthesia is caused mainly by peripheral vasodilatation and is not usually associated with a decrease in cardiac output. Although the intravenous administration of fluids helps to increase cardiac output, it does not always prevent maternal hypotension. Three strategies of fluid administrations are equivalent for the prevention of maternal hypotension and a reduced need for vasopressors: (1) colloid preload; (2) colloid coload; and (3) crystalloid coload. Crystalloid preload is not as effective as any of those three strategies. Unlike phenylephrine, ephedrine can cause fetal acidosis. Therefore, phenylephrine is recommended as first line treatment of maternal hypotension. A phenylephrine infusion (25-50 lgÁmin -1 ) appears to be more effective than phenylephrine boluses to prevent hypotension, and nausea and vomiting. In preeclamptic patients, spinal anesthesia produces less hypotension than in normal pregnant women and fluid volumes up to 1,000 mL are usually well tolerated. Therefore mild to moderate intravascular volume loading is recommended, keeping in mind the increased risk for pulmonary edema in this population. In pre-eclamptic patients, hypotension can be treated either with ephedrine or phenylephrine, and phenylephrine infusions are not recommended.Conclusion A volume loading regimen other than crystalloid preload should be adopted. A phenylephrine infusion during elective Cesarean delivery is beneficial for the mother and safe for the newborn. Objectives of this Continuing Professional Development (CPD) module:After reading this module, the reader should be able to:1. Describe the main hemodynamic changes induced by spinal anesthesia in a pregnant woman undergoing a scheduled Cesarean delivery. 2. Recognize the clinical implications of those hemodynamic changes in the mother and fetus. 3. Explain the various strategies of vascular loading, and their main hemodynamic repercussions. 4. Assess the impact of using phenylephrine and ephedrine for the prevention and treatment of maternal hypotension. 5. Plan the fluid and vasopressor therapy in the case of an urgent Cesarean delivery.The increased popularity of regional anesthesia in clinical practice has led to a decrease in maternal mortality and morbidity related to complications in airway management. Spinal anesthesia is now the most popular technique for Cesarean delivery as it is easy to perform and provides a rapid onset, dense surgical block. It is not associated with a maternal or fetal risk of toxicity to local anesthetics. However, spinal anesthesia is often associated with significant maternal hypotension, with potentially significant consequences on maternal comfort, organ perfusion, and fetal well-being. Several studies suggest that the traditional approach that con...

show abstract

Section: Intravascular Volume Loading Strategiesmentioning

confidence: 91%

Section: Intravascular Volume Loading Strategiesmentioning

confidence: 99%

Section: Les Stratégies De Remplissage Vasculaireunclassified

Section: Le Coremplissage Liquidienunclassified

See 2 more Smart Citations

Fluid and vasopressor management for Cesarean delivery under spinal anesthesia: Continuing Professional Development

Loubert

2012

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

show abstract

“…Por el momento, el estudio de Mcdonald y cols., sigue siendo el único protocolo donde se compara cocarga de cristaloides versus cocarga de coloides, en el cual no se logró encontrar una diferencia significativa en el desenlace primario del estudio que fue gasto cardiaco medido por ecografía doppler. Además, no hubo diferencias en los requerimientos de vasopresores o en la estabilidad hemodinámica, por lo que concluyen que el uso de coloides no ofrece ventajas sobre los cristaloides cuando son utilizados en conjunto con una infusión de fenilefrina durante una anestesia espinal para cesárea electiva 20 .…”

Section: Cocarga Con Coloidesunclassified

Fluidoterapia para la Prevención de Hipotensión Arterial Secundaria a Anestesia Espinal en Operación Cesárea: ¿Tenemos todas las respuestas?

Miranda¹,

Lacassie²

2017

Rev Chil Anest

View full text Add to dashboard Cite

Spinal anesthesia is the technique of choice for patients undergoing cesarean section. One of the most common adverse effects of this technique is arterial hypotension, which if severe, can result in serious maternal and fetal injury or death. Different alternatives exist to prevent and treat hypotension associated to spinal anesthesia; one of them is fluid therapy. the objective of this review is to evaluate the currently available evidence for different fluid therapy alternatives and assess their effectiveness. Nowadays, it does not seem advisable to use preload with crystalloids as evidence suggests its ineffectiveness. As for the other three alternatives (preload with colloids, coload with crystalloids and coload with colloids) there is no superiority among them and neither of them seems effective enough to be used as monotherapy. Due to its safety and ease of use, coload with crystalloids associated to alpha agonist vasopressor therapy seems to be the best management strategy. Further studies should aim at the best way to administer fluids in order to optimize vasopressor therapy. RESUMENLa técnica anestésica de elección para operación cesárea es la anestesia subaracnoídea. Uno de los principales efectos adversos de esta técnica es la hipotensión arterial, que puede llegar a ocasionar graves complicaciones. Existen diversas alternativas para la prevención y manejo de la hipotensión arterial; una de ellas la fluidoterapia. El objetivo de esta revisión es evaluar la evidencia reciente disponible para las distintas alternativas de fluidoterapia y evaluar su efectividad. Actualmente no parece recomendable el utilizar precarga con cristaloides para

show abstract

Techniques for preventing hypotension during spinal anaesthesia for caesarean section

Chooi

Cox

Lumb

et al. 2017

Cochrane Database of Systematic Reviews

View full text Add to dashboard Cite

show abstract

Maternal Cardiac Output Changes After Crystalloid or Colloid Coload Following Spinal Anesthesia for Elective Cesarean Delivery

Cited by 83 publications

References 24 publications

Fluid and vasopressor management for Cesarean delivery under spinal anesthesia: Continuing Professional Development

Fluid and vasopressor management for Cesarean delivery under spinal anesthesia: Continuing Professional Development

Fluidoterapia para la Prevención de Hipotensión Arterial Secundaria a Anestesia Espinal en Operación Cesárea: ¿Tenemos todas las respuestas?

Techniques for preventing hypotension during spinal anaesthesia for caesarean section

Contact Info

Product

Resources

About