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The Effects of Crystalloid Coload Compared to Colloid Preload on Vasopresor Use and Hypotension for Cesarean Delivery under Spinal Anesthesia
Abstract Number: T-40
Abstract Type: Original Research
Introduction: Fluid loading is used to prevent spinal hypotension during cesarean delivery (CD), however the optimal fluid type and timing of fluid administration remain uncertain (1). The aim of this comparative effectiveness study was to compare vasopressor use and hemodynamics among women receiving a colloid preload versus a crystalloid coload for CD under spinal anesthesia.
Methods: We sequentially reviewed the medical records of women undergoing elective CD before and after an institutional practice change for fluid loading in August 2013 driven by an FDA warning for hydroxyethyl starches. Colloid preloading with 500 ml 6% hetastarch was used before and crystalloid coloading with 1000 ml crystalloid after the change. Inclusion criteria were: healthy women with singleton term pregnancies receiving spinal anesthesia (hyperbaric bupivacaine 12 mg, fentanyl 10 mcg, and morphine 100-200 mcg). Primary outcome was total phenylephrine (PE) dose administered from spinal block to delivery. Secondary outcomes were: maternal hemodynamics, estimated blood loss (EBL), and hemoglobin (Hb) values.
Results: 79 women received colloid preloading and 77 women received crystalloid coloading. The total PE dose was significantly lower in the colloid vs. the crystalloid group (489 ± 403 mcg vs. 647 ± 464 mcg respectively, P=0.02). 98% of women in the colloid preload group required phenylephrine compared to 92% in the crystalloid coload group (p=0.14). There were no differences in systolic BP or heart rate between groups; however, maximal decrease in systolic BP was greater in the colloid group (Table). Although EBL values were similar in both groups, there was a greater decrease in Hb values in the colloid group (Table).
Conclusion: Women in the colloid group received a significantly lower total dose of PE compared to women in the crystalloid group; however, this difference is likely to be clinically insignificant as it equates to approximately two 100 mcg PE doses. The smaller maximum drop in systolic BP may be a result of the high flow rate inherent with crystalloid coloading which reduced the delivery time of each PE bolus. The smaller decrease in Hb change among women in the colloid group was likely secondary to a lesser degree of hemodilution.
1. Curr Opin Anaesthesiol 2012;25:286-291