Crystalloid Preload Plus Crystalloid Coload for Management of Hypotension During Subarachnoid Block for Emergency Caesarean Section

Abstract

Background: Maternal hypotension following spinal anaesthesia remains a persistent major clinical burden. Several physical methods, fluid loading, dose adjustments, addition of opioids or vasopressors have been tried alone or in combinations but with controversial findings.
Purpose: To determine whether crystalloid coloading will enhance control of maternal hypotension  provided by crystalloid preloading during spinal anaesthesia.
Patients and Methods: Women in preload group (PL, n=25) received 15ml/kg normal saline within 15 minutes before induction of spinal anaesthesia, then had  maintenance infusion of 20ml/kg normal saline for the next one hour. Those in coload group (CL, n=25) received 15ml/kg normal saline within 15 minutes following  induction of spinal anaesthesia, then had maintenance infusion of 20ml/kg normal saline for the next one hour. The parturients in combined preloadcoload group (BL) received 15ml/kg normal saline within 15 minutes before spinal anaesthesia and 15ml/kg normal saline within 15 minutes following induction of spinal anesthesia,   then had maintenance infusion of 5ml/kg normal saline over one hour. Maternal hypotension, total rescue fluid, neonatal outcome and ephedrine used were  documented.
Results: Incidence of hypotension was significantly higher among patients in preload group 15(60%) and coload group 18(75%) compared to combined group 4  (16.7%) (p=0.0001). The mean dose of ephedrine administered following hypotension was significantly higher in coload group (15.2 ± 3.2 mg) and preload group (12.3 ± 1.4 mg) compared to combined group (3.1 ± 0.9 mg) (P=0.0001). Neonatal outcome was similar in the three groups.
Conclusion: Combined crystalloid preload-coload is a better prophylactic method of managing spinal-induced hypotension than crystalloid preload or coload alone in women undergoing caesarean section under subarachnoid block.

Keywords: caesarean section, hypotension, preload, preload-coload, spinal anaesthesia