Comparison between colloid preload and crystalloid co-load in cesarean section under spinal anesthesia: a randomized...

Area of Science:

• Anesthesiology
• Obstetrics
• Pharmacology

Background:

• Hypotension is a frequent complication of spinal anesthesia during cesarean delivery.
• Intravenous fluid administration aims to prevent dehydration and mitigate hypotension.
• A direct comparison between colloid preload and crystalloid co-load for hypotension prevention is lacking.

Purpose of the Study:

• To compare the efficacy of colloid preload versus crystalloid co-load in preventing hypotension during spinal anesthesia for cesarean delivery.
• To evaluate secondary outcomes including severe hypotension, vasopressor requirements, and maternal and neonatal well-being.

Main Methods:

• A randomized, double-blind study involving 210 patients undergoing elective cesarean section under spinal anesthesia.
• Patients received either 500 mL of 6% hydroxyethyl starch (colloid preload) or 1000 mL of Ringer's acetate (crystalloid co-load).
• Hypotension was defined as systolic blood pressure <80% of baseline or <90 mmHg; severe hypotension was <80 mmHg. Ephedrine was used for treatment.

Main Results:

• No significant difference in the incidence of hypotension (52.4% vs. 42.2%) or severe hypotension (15.5% vs. 9.8%) between the colloid preload and crystalloid co-load groups.
• Median ephedrine doses were similar, with no significant differences in maternal nausea/vomiting or neonatal outcomes.
• Data analyzed from 205 patients (103 colloid, 102 crystalloid).

Conclusions:

• A 1000 mL crystalloid co-load is as effective as a 500 mL colloid preload in reducing hypotension post-spinal anesthesia for cesarean delivery.
• Neither fluid regimen alone can completely prevent hypotension.
• Concomitant use of vasopressors remains essential for managing hypotension in this setting.