Relevance of rapid crystalloid administration after spinal anaesthesia (coload) in prevention of hypotension during elective caesarean section

Bouchnak, M.; Cheikh, Nathalie; Skhiri, Alia; Yaacoubi, M. El; Menif, M. A.; Smaoui, M.; Maghrebi, H.

doi:10.1097/00003643-200606001-00638

Cited by 6 publications

(8 citation statements)

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“…We found three additional references in abstract form. [16][17][18] Thus, we retrieved eight randomized controlled trials with a total of 518 patients. There was no evidence of publication bias seen in the funnel plot (Fig.…”

Section: Resultsmentioning

confidence: 99%

“…Hypotension was defined by the authors as a 20% reduction of systolic blood pressure from baseline in five studies, [10][11][12][13]16 a 20% reduction and a systolic blood pressure less than 100 mmHg in one study, 18 and a reduction of 10% in two studies. 14,17 The incidence of hypotension in the coload group was 159/268 (59.3%) compared with 156/250 (62.4%) in the preload group (OR 0.93; 95% CI 0.54, 1.6).…”

Section: Incidence Of Hypotensionmentioning

confidence: 99%

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Preload or coload for spinal anesthesia for elective Cesarean delivery: a meta-analysis

Banerjee

Stocche

Angle

et al. 2009

Can J Anesth/J Can Anesth

119

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Background Hypotension following spinal anesthesia for Cesarean delivery is common. Fluid loading is recommended to prevent hypotension, but preload is often ineffective. In non-pregnant patients, coloading has been shown to better maintain cardiac output after spinal anesthesia. The purpose of this meta-analysis was to determine whether the timing of the fluid infusion, before (preload) or during (coload) induction of spinal anesthesia for Cesarean delivery, influences the incidence of maternal hypotension or neonatal outcome. Methods We retrieved randomized controlled trials that compared a fluid preload with coload in patients undergoing spinal anesthesia for elective Cesarean delivery. We graded the articles for quality of reporting (maximum score = 5) and recorded the incidence of hypotension, lowest blood pressure, the incidence of maternal nausea and vomiting, umbilical cord pH, and Apgar scores. We combined the results using random effects modelling. Results We retrieved eight studies comprised of 518 patients. The median quality score for the published studies was three. The incidence of hypotension in the coload group was 159/268 (59.3%) compared with 156/250 (62.4%) in the preload group (odds ratio [OR] = 0.93; 95% confidence interval [CI] 0.54-1.6). There were no significant differences between groups in any of the other outcomes. Conclusions It is unnecessary to delay surgery in order to deliver a preload of fluid. Regardless of the fluid loading strategy, the incidence of maternal hypotension is high. Prophylactic or therapeutic vasopressors may be required in a significant proportion of patients. RésuméContexte L'hypotension est un phe´nome`ne courant a`la suite d'une rachianesthe´sie pour un accouchement par ce´sarienne. Il est recommande´d'administrer une charge liquidienne pour pre´venir l'hypotension, mais la pre´-charge est souvent peu efficace. Chez les patients et patientes non enceintes, il a e´te´de´montre´que la co-charge maintenait mieux le de´bit cardiaque apre`s une rachianesthe´sie. L'objectif de cette me´ta-analyse e´tait de de´terminer si le moment de perfusion liquidienne, soit avant (pre´-charge) ou pendant (co-charge) l'induction de la rachianesthe´sie pour un accouchement par ce´sarienne, influençait l'incidence d'hypotension chez la me`re ou le devenir du nouveau-ne´. Méthode Nous avons extrait des e´tudes randomise´es contrôle´es comparant une pre´-charge a`une co-charge liquidienne chez des patientes subissant une rachianesthe´sie pour un accouchement par ce´sarienne non urgent. Nous avons attribue´une note aux articles selon la qualite´de la pre´sentation (score maximal = 5) et note´l'incidence d'hypotension, la tension arte´rielle la plus basse, l'incidence de nause´es et vomissements chez la me`re, le pH du sang du cordon ombilical et les scores d'Apgar. Nous avons combine´les re´sultats a`l'aide d'un mode`le a`effets ale´atoires. 123Can J Anesth/J Can Anesth (2010) 57:24-31 DOI 10.1007 Résultats Nous avons retenu huit e´tudes comprenant 518 patientes. Le score ...

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Section: Resultsmentioning

confidence: 99%

Section: Incidence Of Hypotensionmentioning

confidence: 99%

Preload or coload for spinal anesthesia for elective Cesarean delivery: a meta-analysis

Banerjee

Stocche

Angle

et al. 2009

Can J Anesth/J Can Anesth

119

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“…Cardoso et al 26 observed the incidence of hypotension as 22.5% and 25% in the co-load and preload groups respectively 26 . In contrast to above findings, Bouchnak et al 27 who compare 20 ml/kg of crystalloid as co-load or preload in the parturient noticed a higher incidence of hypotension in the co-load group (96.6%) versus preload group (86.6%) 27 . The differences in these studies may be due to the different amount of crystalloids used, definitions of hypotension used in the studies vary, height of block, drugs effect and the difference in the rates of administration of the crystalloids.…”

Section: Discussionmentioning

confidence: 75%

A Comparison of Crystalloid Preloading and Co-Loading to Prevent Spinal Anaesthesia Induced Hypotension in Caesarean Section

Haque

Aleem

Chowdhury

et al. 2017

j Bangladesh Soc Anaesthesiologists

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Background: Preloading of crystalloid is a traditional practice to prevent spinal anaesthesia inducedhypotension. But co-loading seems to be more physiological and rational approach as effect was achievedduring the time of spinal anaesthesia. Aims: To compare the efficacy of crystalloid preloading and co-loading for prevention of hypotensionduring spinal anaesthesia in caesarean section. Methods: This study was conducted in Department of Anaesthesia, Analgesia and Critical Care, CombinedMilitary Hospital (CMH), Chittagong. Study was carried out over a period of six months from January toJune 2017. Total 80 patients (40 in each group) were included in this study. Patients with ASA grade 1& 2, aged 18-40 years were included. Patients with complicated pregnancy or failed spinal were excluded.Group-P (Preload group) received 15ml/kg Crystalloid solution (Hartmann’s solution/lactated Ringer’ssolution), 20 min before administration of spinal anaesthesia. Group-C (Co-load group) received bolus of15 ml/kg Crystalloid solution (Hartmann’s solution /lactated Ringer’s solution) at time of administrationof spinal anaesthesia. Blood pressure was recorded at 1, 2, 3, 5 & 10 minutes. Patients received vasopressorswhen mean blood pressure reduced below 20 mm of Hg or systolic blood pressure dropped below 90mmHg. Results: Total study population was 80 patients underwent caesarean section. Mean age of the patientswas 28.36±5.08 years and 28.25±5.06 years in group-P and C, respectively. Overall hypotension was notedin 23 patients (57.5%) of group-P and 19 patients (47.5%) of group-C. The difference between two groupswas statistically insignificant (p=0.241). After induction of spinal anaesthesia at 1 minute hypotensionwas noted in 7 patients (17.5%) of group-P and in 13 patients (32.5%) of group-C, at 2 minutes in 21patients (52.5%) of group-P and in 22 patients (55%) of group-C, at 3 minutes in 23 patients (57.5%) ofgroup-P and in 24 patients (60.0%) of group-C, at 5 minutes in 17 patients (42.5%) of group-P and in 19patients (47.5%) of group-C, at 10 minutes in 13 patients (32.5%) of group-P and in 7 patients (17.5%) ofgroup-C hypotension was developed. Conclusion: Both preloading and co-loading with 15 ml/kg of Crystalloid solution (Hartmann’s solution/lactated Ringer’s solution) when used alone, are ineffective for the prevention of hypotension in caesareansection receiving spinal anaesthesia. We recommend frequent monitoring of maternal blood pressure andprompt treatment of maternal hypotension with vasopressors for better neonatal outcomes. JBSA 2017; 30(2): 83-89

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“…37 In contrast to these findings, Teoh and Sia et al found that 15ml/kg colloid preload but not coload significantly increased maternal cardiac output within the first 5minutes after spinal injection, with no difference in the incidence of hypotension.38 Similarly Bouchnak et al, reported higher incidence of hypotension in the coload group (96.6%) than in the preload group (86.6%) while comparing 20ml/kg of crystalloid as coload or preload in obstetric population. 39 The wide variation in the incidence of hypotension in these studies may be explained by differences in the definition of hypotension and different volumes and protocols of fluid administration used in the studies. 32 In our study, the mean arterial pressure between the two groups was comparable and the difference was statistically insignificant at all measured intervals.…”

Section: Discussionmentioning

confidence: 99%

Comparative study to evaluate the effect of colloid coloading versus crystalloid coloading for prevention of spinal anaesthesia induced hypotension and effect on fetal Apgar score in patients undergoing elective lower segment caesarean section: a prospective observational study

Wani¹,

Pandit²,

Din³

et al. 2018

Int J Reprod Contracept Obstet Gynecol

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Background: Spinal anesthesia for LSCS has a high incidence of maternal hypotension which can be severe and disastrous for the fetus and the mother. Coloading in these patients is a physiologically more appropriate method for preventing spinal anesthesia induced hypotension.Methods: 100 ASA I patients for elective LSCS were randomly divided into two equal groups to either receive 1000ml colloid (6% Hetastarch) or 1000ml crystalloids (Ringer lactate) as coload. NIBP, heart rate SPO2 and incidence of nausea and vomiting and use of ephedrine to treat any hypotension was recorded. Fetal outcome was measured using APGAR score at 0, 1 and 5 minutes.Results: The incidence of hypotension was lesser with colloid coload group (41.7%) as compared to the crystalloid coload group (58.3%) but the difference between the two groups was statistically insignificant. Similarly, no statistically significant difference was noted in the incidence of nausea and vomiting and Fetal APGAR score between the two groups.Conclusions: Both Colloid and Crystalloid coloading is effective in decreasing the incidence of spinal anesthesia induced hypotension during LSCS with lesser incidence of hypotension and nausea vomiting with colloid coloading.

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Relevance of rapid crystalloid administration after spinal anaesthesia (coload) in prevention of hypotension during elective caesarean section

Cited by 6 publications

References 0 publications

Preload or coload for spinal anesthesia for elective Cesarean delivery: a meta-analysis

Preload or coload for spinal anesthesia for elective Cesarean delivery: a meta-analysis

A Comparison of Crystalloid Preloading and Co-Loading to Prevent Spinal Anaesthesia Induced Hypotension in Caesarean Section

Comparative study to evaluate the effect of colloid coloading versus crystalloid coloading for prevention of spinal anaesthesia induced hypotension and effect on fetal Apgar score in patients undergoing elective lower segment caesarean section: a prospective observational study

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