当前位置： SCI文献检索 > ANESTHESIA AND ANALGESIA期刊下所有文献 > A randomized trial comparing colloid preload to coload during spinal anesthesia for elective cesarean delivery.

A randomized trial comparing colloid preload to coload during spinal anesthesia for elective cesarean delivery.

Abstract：

BACKGROUND:Hypotension after spinal anesthesia for cesarean delivery is common. Previous studies have demonstrated that a crystalloid fluid "coload" (rapid administration of a fluid bolus starting at the time of intrathecal injection) is superior to the conventional crystalloid preload (fluid administered before the intrathecal injection) for preventing hypotension. Colloid preload provides a sustained increase in central blood volume. We hypothesized that, in contrast to crystalloid, a colloid preload may be more effective than colloid coload for reducing the incidence of spinal anesthesia-induced hypotension. METHODS:In this double-blind study, 178 patients were randomly assigned to receive a preload of 500 mL of hydroxyethyl starch over a period of 15-20 min before initiation of spinal anesthesia (n = 90) or an identical fluid bolus of hydroxyethyl starch starting at the time of identification of cerebrospinal fluid (n = 88). Vasopressors (ephedrine or phenylephrine) were administered if systolic arterial blood pressure decreased less than 80% of the baseline pressure and <100 mm Hg, or with smaller decreases in blood pressure if accompanied by nausea, vomiting, or dizziness. The primary outcome was the incidence of hypotension (defined as the administration of at least one dose of vasopressor). RESULTS:There was no significant difference between the groups in the incidence of hypotension (68% in preload group and 75% in coload group, 95% confidence interval of difference -6%-20%; P = 0.28), doses of ephedrine and phenylephrine, and number of vasopressor unit doses. The incidence of severe hypotension (systolic blood pressure <80 mm Hg) was 16% in the preload group and 22% in the coload group (P = 0.30). There were no differences in the incidence of nausea and/or vomiting, or neonatal outcome between the groups. CONCLUSION:There was no difference in the incidence of hypotension in women who received colloid administration before the initiation of spinal anesthesia compared with at the time of initiation of anesthesia. Both modalities are inefficient as single interventions to prevent hypotension.

journal_name

Anesth Analg

journal_title

Anesthesia and analgesia

authors

Siddik-Sayyid SM,Nasr VG,Taha SK,Zbeide RA,Shehade JM,Al Alami AA,Mokadem FH,Abdallah FW,Baraka AS,Aouad MT

doi

10.1213/ane.0b013e3181b2bd6b

subject

Has Abstract

pub_date

2009-10-01 00:00:00

pages

1219-24

issue

eissn

0003-2999

issn

1526-7598

pii

ane.0b013e3181b2bd6b

journal_volume

109

pub_type

杂志文章,随机对照试验

在线工具

A randomized trial comparing colloid preload to coload during spinal anesthesia for elective cesarean delivery.