Warm or cold saline for volume preload before spinal anaesthesia for caesarean section?

Area of Science:

• Anesthesiology
• Obstetrics
• Cardiovascular Physiology

Background:

• Spinal anesthesia commonly causes hypotension in parturients undergoing cesarean delivery.
• Intravenous fluid administration is a standard method to prevent or treat this hypotension.
• The temperature of infused fluids may influence hemodynamic responses.

Purpose of the Study:

• To compare the efficacy of warm versus cold isotonic saline for preventing spinal anesthesia-induced hypotension in parturients undergoing elective cesarean section.

Main Methods:

• A randomized controlled trial involving 113 parturients undergoing elective cesarean section.
• Patients received either warm (37°C) or cold (21°C) isotonic saline infusions pre- and post-spinal anesthesia.
• Hemodynamic parameters, ephedrine requirements, and patient comfort were monitored.

Main Results:

• While the cold saline group exhibited slightly higher mean arterial pressure post-spinal anesthesia, the difference was not clinically significant (approximately 5 mmHg).
• Discomfort in the infusion arm was lower in the warm saline group (P<0.01).
• The incidence of shivering and the need for ephedrine did not differ significantly between the groups.

Conclusions:

• Intravenous fluid temperature (warm vs. cold saline) is not a critical factor in managing spinal anesthesia-induced hypotension during cesarean sections.
• The clinical significance of minor hemodynamic variations due to fluid temperature is minimal in this context.