The Effects of Pre-Spinal Anesthesia Administration of Crystalloid and Colloid Solutions on Hypotension in Elective Cesarean Section

Gousheh, Mohammad Reza; Akhondzade, Reza; Aghahoseini, Hamid Asl; Olapour, Alireza; Rashidi, Mahbobe

doi:10.5812/aapm.69446

Cited by 13 publications

(18 citation statements)

References 18 publications

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“…We included 109 out of 1021 retrieved trials, which included 8561 women (Fig. and see also Supporting Information, Table S1) . Twelve interventions (eleven active treatments and one inactive control) to prevent intra‐operative hypotension were studied, with 30 direct comparisons (see also Supporting Information, Table S2).…”

Section: Resultsmentioning

confidence: 99%

Prevention of hypotension after spinal anaesthesia for caesarean section: a systematic review and network meta‐analysis of randomised controlled trials

et al. 2019

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Summary Spinal anaesthesia for caesarean section commonly causes maternal hypotension. This systematic review and network meta‐analysis compared methods to prevent hypotension in women receiving spinal anaesthesia for caesarean section. We selected randomised controlled trials that compared an intervention to prevent hypotension with another intervention or inactive control by searching MEDLINE and Embase, Web of Science to December 2018. There was no language restriction. Two reviewers extracted data on trial characteristics, methods and outcomes. We assessed risk of bias for individual trials (Cochrane tool) and quality of evidence (GRADE checklist). We assessed 109 trials (8561 women) and 12 different methods that resulted in 30 direct comparisons. Methods ranked by OR (95%CI) from most effective to least effective were: metaraminol 0.11 (0.04–0.26); norepinephrine 0.13 (0.06–0.28); phenylephrine 0.18 (0.11–0.29); leg compression 0.25 (0.14–0.43); ephedrine 0.28 (0.18–0.43); colloid given before induction of anaesthesia 0.38 (0.24–0.61); angiotensin 2, 0.12 (0.02–0.75); colloid given after induction of anaesthesia 0.52 (0.30–0.90); mephentermine 0.09 (0.01–1.30); crystalloid given after induction of anaesthesia 0.78 (0.46–1.31); and crystalloid given before induction of anaesthesia 1.16 (0.76–1.79). Phenylephrine caused maternal bradycardia compared with control, OR (95%CI) 0.23 (0.07–0.79). Ephedrine lowered umbilical artery pH more than phenylephrine, standardised mean difference (95%CI) 0.78 (0.47–1.49). We conclude that vasopressors should be given to healthy women to prevent hypotension during caesarean section with spinal anaesthesia.

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Section: Resultsmentioning

confidence: 99%

Prevention of hypotension after spinal anaesthesia for caesarean section: a systematic review and network meta‐analysis of randomised controlled trials

et al. 2019

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“…Bupivacaine alone can prolong the sensory and motor blockades in spinal anesthesia for lower limb surgery, compared with the combination of 10 µg epinephrine and 5 µg sufentanil (13), but the simultaneous use of dexmedetomidine and bupivacaine in spinal anesthesia for intrathecal analgesia has a longer duration of sensory and motor blockage and longer postoperative analgesia with lower side effects (14). Adding intrathecal magnesium sulphate to bupivacaine in patients under lower extremity surgeries is a safe and effective adjuvant therapeutic method for enhancing onset time of motor block (15)(16)(17).…”

Section: Introductionmentioning

confidence: 99%

Comparing the Effect of Bupivacaine and Ropivacaine in Cesarean Delivery with Spinal Anesthesia

et al. 2020

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Background: Spinal anesthesia is the most common technique used for cesarean delivery due to some advantages compared to regional anesthesia. It is easily performed and provides a rapid onset of block. Though bupivacaine is a generally used long-acting amide type local anesthetic drug for spinal anesthesia, ropivacaine may sometimes be selected. Objectives: This prospective, randomized, double-blinded study was aimed at comparing clinical efficacy and safety between ropivacaine and bupivacaine during cesarean section. Methods: After getting ethical committee approval and written informed consent, 65 women who referred to Imam Khomeini Hospital of Ahvaz, Iran in 2018 were chosen for elective cesarean delivery under spinal anesthesia. They were randomly allocated to receive either ropivacaine 1% (n = 33) or bupivacaine 0.5% (n = 32). Afterwards, the differences in the anesthetic efficacy, vital signs, and hemodynamics of participants between the two groups were recorded. Results: Duration of sensory block was shorter in the ropivacaine group than bupivacaine group (132.5 ± 21.6 min vs. 175.8 ± 26.2 min; P < 0.001). Ropivacaine also produced a shorter duration of motor blockade than bupivacaine (124.8 ± 20.2 min vs. 168.2 ± 21.7 min; P < 0.001). There is no difference between the two groups in terms of systolic and diastolic blood pressure, but the heart rate of patients in the bupivacaine group is significantly higher than the ropivacaine group. Conclusions: The results suggest that ropivacaine and bupivacaine are two efficient drugs in anesthesia in the cesarean section, ropivacaine is a better choice due to little influence on the hemodynamics and shorter duration of sensory block and motor block which are useful for the recovery and also safe to the patients.

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“…Nineteen studies including 1472 women provided usable data for the effect of fluid preloading on ephedrine requirement. [ 15 , 17 , 18 , 20 – 22 , 24 , 25 , 28 , 29 , 31 – 36 , 40 , 42 , 43 , 47 ] The requirement of ephedrine with colloid preloading was lower than that with crystalloid preloading (standardized mean difference: -0.37, 95% CI: -0.64 to -0.09; P = .009; Fig. 4 ).…”

Section: Resultsmentioning

confidence: 99%

“…We selected and included a final 33 RCTs for the final analysis. [ 15 – 47 ] Figure 1 shows the flow chart of the study selection process.…”

Section: Resultsmentioning

confidence: 99%

“…The incidence of intraoperative nausea and/or vomiting was reported in 20 trials. [ 15 , 17 , 20 , 23 , 24 , 26 , 27 , 29 , 30 , 32 – 35 , 37 , 39 – 42 , 44 , 47 ] Among these trials, a statistically significant reduction in nausea and/or vomiting was found when colloid preloading was administered compared with crystalloid preloading (risk ratio: 0.72, 95% CI: 0.55–0.95; 1601 women; P = .02; Fig. 5 ) with mild heterogeneity ( I 2 = 36%).…”

Section: Resultsmentioning

confidence: 99%

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Colloid preloading versus crystalloid preloading to prevent hypotension after spinal anesthesia for cesarean delivery

Shang

et al. 2021

Medicine

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Background: Maternal hypotension is the most frequent complication of spinal anesthesia for cesarean delivery, and intravenous fluid preloading is a preventive measure. We aimed to assess the efficacy of colloids versus crystalloids for preloading to reduce the incidence of spinal anesthesia-induced hypotension and vasopressor requirement in healthy parturients during elective cesarean delivery. Methods: We searched the Cochrane Library, MEDLINE and EMBASE to identify all studies published to June, 2019, through OVID and PubMed. We included randomized controlled trials, comparing colloid preloading with crystalloid preloading in women having spinal anesthesia for cesarean delivery. Primary outcomes were the incidence of hypotension and vasopressor requirement. Secondary outcomes included nausea and/or vomiting, neonatal Apgar score, neonatal umbilical blood pH. We used standardized mean differences for expressing continuous outcomes and risk ratios for dichotomous outcomes. Random-effect model was performed to estimate the pooled risk ratios and standardized mean differences. Results: Thirty-three randomized controlled trials contributed data for this meta-analysis. Fewer women experienced hypotension in the colloid group compared with the crystalloid group (risk ratio: 0.72, 95% confidence interval: 0.63–0.82; 2566 women, 32 studies; P < .00001). The total ephedrine dose required was significantly lower with colloid preloading (standardized mean difference: −0.37, 95% CI: −0.64 to −0.09; 1472 women, 19 studies; P = .009). Colloid preloading was also associated with fewer phenylephrine requirement compared with crystalloid preloading (standardized mean difference: -0.54, 95% CI: -0.82 to -0.25; 169 women; P = .0002). The incidence of nausea and/or vomiting was significantly reduced with colloid preloading (risk ratio: 0.72, 95% CI: 0.55–0.95; 1601 women, 20 studies; P = .02). However, the incidence of 1-minute Apgar score < 7, umbilical artery pH < 7.2 and umbilical vein pH < 7.2 were not statistically different between groups. Conclusions: Colloid preloading is superior to crystalloid preloading in reducing the incidence of hypotension induced by spinal anesthesia and vasopressor requirement in the healthy parturients undergoing elective cesarean delivery. The PROSPERO registration number: CRD42018096402.

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The Effects of Pre-Spinal Anesthesia Administration of Crystalloid and Colloid Solutions on Hypotension in Elective Cesarean Section

Cited by 13 publications

References 18 publications

Prevention of hypotension after spinal anaesthesia for caesarean section: a systematic review and network meta‐analysis of randomised controlled trials

Prevention of hypotension after spinal anaesthesia for caesarean section: a systematic review and network meta‐analysis of randomised controlled trials

Comparing the Effect of Bupivacaine and Ropivacaine in Cesarean Delivery with Spinal Anesthesia

Colloid preloading versus crystalloid preloading to prevent hypotension after spinal anesthesia for cesarean delivery

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