The Crystalloid Co-load: Clinically as Effective as Colloid Preload for Preventing Hypotension from Spinal Anaesthesia For Caesarean Delivery [Turk J Anaesthesiol Reanim]
Turk J Anaesthesiol Reanim. Ahead of Print: TARD-76402

The Crystalloid Co-load: Clinically as Effective as Colloid Preload for Preventing Hypotension from Spinal Anaesthesia For Caesarean Delivery

Edward T Riley1, Kevin Mangum2, Brendan Carvalho1, Alexander J Butwick1
1Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA. 94305 USA
2A.T. Still University School of Osteopathic Medicine in Arizona, Meza, AZ US

Objective: Colloid preloading diminishes post-spinal hypotension, however it remains uncertain whether colloid preloading is superior to crystalloid co-loading. In this retrospective study, we compared the effects of a colloid preload versus a crystalloid co-load on vasopressor requirements and maternal haemodynamics among women undergoing elective cesarean delivery with spinal anaesthesia.
Methods: We abstracted data from the medical records of 160 healthy women who underwent elective cesarean delivery with spinal anaesthesia at an academic obstetric center before and after an institutional fluid loading protocol change. Patients received a 500 ml 6% hydroxyethyl starch preload or a 1000 ml crystalloid co-load. The primary outcome was the total phenylephrine dose administered from spinal block placement to delivery.
Results: Our cohort comprised 79 women in colloid group and 77 women in crystalloid group. Mean SD phenylephrine use was significantly lower in the colloid group compared to the crystalloid group (489 403 mcg vs. 647 464 mcg respectively, p=0.02). The maximal drop in systolic blood pressure was greater in the colloid group compared to the crystalloid group (36 20 mmHg versus 29 16 mmHg respectively, p = 0.02). There were no clinically significant differences between groups in heart rate, blood loss, temperature and Apgar scores.
Conclusion: Vasopressor use was lower with colloid preloading compared to crystalloid co-loading; however, differences in all outcome measures were small and likely clinical insignificant, suggesting that both fluids loading techniques are appropriate to use for the prevention of spinal hypotension in women undergoing caesarean delivery.

Keywords: Spinal anesthesia, hetastarch, crystalloid, preload, co-load, phenylephrine




Corresponding Author: Edward T Riley, United States


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