A randomized trial of crystalloid versus colloid solution for prevention of hypotension during spinal or low-dose combined spinal-epidural anesthesia for elective cesarean delivery

• Published in: International journal of obstetric anesthesia Vol. 16; no. 1; pp. 8 - 12
• Main Authors: Ko, J-S, Kim, C-S, Cho, H-S, Choi, D-H
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01-01-2007
• Subjects: Adult; Analysis of Variance; Anesthesia & Perioperative Care; Anesthesia, Epidural - adverse effects; Anesthesia, Spinal - adverse effects; Anesthetics, Combined; Bupivacaine; Cesarean delivery; Cesarean Section; Colloid; Combined spinal-epidural anesthesia; Crystalloid; Double-Blind Method; Female; Fentanyl; Humans; Hydroxyethyl Starch Derivatives - therapeutic use; Hypotension - etiology; Hypotension - prevention & control; Isotonic Solutions - therapeutic use; Nausea - etiology; Nausea - prevention & control; Obstetrics and Gynecology; Pregnancy; Preload; Prospective Studies; Spinal anesthesia; Cesarean delivery; Crystalloid; Preload; Combined spinal-epidural anesthesia; Colloid; Spinal anesthesia
• ISSN: 0959-289X; 1532-3374
• DOI: 10.1016/j.ijoa.2006.07.004

Background Spinal anesthesia for cesarean delivery is commonly associated with hypotension and nausea and vomiting, and preload with crystalloid or colloid solution is widely recommended. Low-dose spinal via the combined spinal-epidural technique appears to cause less hypotension and nausea and vomiting. The aim of this study was to investigate whether the combined use of colloid preload and combined spinal-epidural technique might further reduce the rates of these symptoms. Methods Women undergoing elective cesarean delivery were randomly allocated to one of four groups (50 in each) to receive crystalloid preload before spinal anesthesia, colloid preload before spinal anesthesia, crystalloid preload before combined spinal-epidural anesthesia, and colloid preload before combined spinal-epidural anesthesia. The incidences of hypotension and nausea and vomiting were compared. Spinal anesthesia was performed with 0.5% hyperbaric bupivacaine 9 mg and fentanyl 20 μg, and combined spinal-epidural anesthesia with 0.5% hyperbaric bupivacaine 6 mg + fentanyl 20 μg followed by epidural injection of 0.25% bupivacaine 10 mL. Results The frequencies of hypotension were 44%, 18%, 24%, and 20% in crystalloid preload-spinal anesthesia, colloid preload-spinal anesthesia, crystalloid preload-combined spinal epidural anesthesia, and colloid preload-combined spinal epidural anesthesia groups, respectively. The frequencies of nausea and vomiting were 20%, 2%, 8%, and 4% in respective groups. Conclusion Colloid preload and low-dose spinal anesthesia alone or in combination lowered the incidences of hypotension and nausea. However, the combination of two methods failed to demonstrate further decreases in the incidence of the symptoms compared to the colloid-spinal anesthesia or crystalloid-combined spinal-epidural anesthesia groups.