| The effects of crystalloid and colloid preload on cardiac output in the parturient undergoing planned cesarean delivery under spinal anesthesia: a randomized trial. | |
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MedLine Citation:
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PMID: 19923521 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Hypotension after spinal anesthesia for cesarean delivery remains a major clinical problem. Fluid preloading regimens together with vasopressors have been used to reduce its incidence. Previous studies have used noninvasive arterial blood pressure measurement and vasopressor requirements to evaluate the effect of preload. We used a suprasternal Doppler flow technique to measure maternal cardiac output (CO) and corrected flow time (FTc, a measure of intravascular volume) before and after spinal anesthesia after 3 fluid preload regimens. We hypothesized that colloid solutions, compared with crystalloid, would produce the largest increase in CO and have the lowest incidence of hypotension. METHODS: Sixty healthy term women scheduled for planned cesarean delivery under spinal anesthesia were recruited for this randomized, double-blind study. Baseline heart rate, systolic blood pressure (SBP), CO, and FTc were recorded in the left lateral tilt position. Patients were randomized to receive 1 of 3 fluid preload regimens given over 15 min: 1.5 L crystalloid (Hartman's solution), 0.5 L of 6% w/v hydroxyethyl starch (HES) solution (HES 0.5), or 1 L of 6% w/v HES solution (HES 1.0). Further measurements were made after fluid loading every 5 min for 30 min. After 30 min, spinal anesthesia was induced with hyperbaric bupivacaine 12.5 mg with fentanyl 15 microg and recordings were continued every 5 min for 20 min or until surgery started. The primary outcome, CO, was compared among groups. The incidence of hypotension (defined as a 20% reduction in SBP from the baseline), ephedrine use, and umbilical cord blood gases were also compared. RESULTS: Patient characteristics, heart rate, SBP, and cord gases were similar among groups. Although CO and FTc increased after preload in all groups (P < 0.005), this was only maintained with HES 1.0 after spinal anesthesia (P < 0.005). There were no differences among groups in the incidence of hypotension (70% vs 35% vs 65% for Hartman's solution, HES 0.5, and HES 1.0, respectively; P = 0.069) or mean ephedrine dose (10.4 vs 5.7 vs 9.7 mg; P = 0.26). CONCLUSION: Despite CO and FTc increases after fluid preload, particularly with HES 1.0 L, hypotension still occurred. The data suggest that CO increases after these preload regimens cannot compensate for reductions in arterial blood pressure after spinal anesthesia. |
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Authors:
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Perumal Tamilselvan; Roshan Fernando; Johanna Bray; Manisha Sodhi; Malachy Columb |
Publication Detail:
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Type: Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Anesthesia and analgesia Volume: 109 ISSN: 1526-7598 ISO Abbreviation: Anesth. Analg. Publication Date: 2009 Dec |
Date Detail:
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Created Date: 2009-11-20 Completed Date: 2009-12-03 Revised Date: 2010-02-22 |
Medline Journal Info:
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Nlm Unique ID: 1310650 Medline TA: Anesth Analg Country: United States |
Other Details:
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Languages: eng Pagination: 1916-21 Citation Subset: AIM; IM |
Affiliation:
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Department of Anesthesia, Princess Alexandra Hospital, Harlow, UK. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Anesthesia, Spinal / adverse effects* Blood Volume / drug effects Carbon Dioxide / blood Cardiac Output / drug effects* Cesarean Section* Colloids / therapeutic use* Double-Blind Method Ephedrine / therapeutic use Female Fetal Blood / metabolism Heart Rate / drug effects Hetastarch / therapeutic use* Humans Hypotension / etiology, physiopathology, prevention & control*, ultrasonography Isotonic Solutions / therapeutic use* Oxygen / blood Plasma Substitutes / therapeutic use* Pregnancy Thymol / therapeutic use* Time Factors Treatment Outcome Ultrasonography, Doppler Vasoconstrictor Agents / therapeutic use |
| Grant Support | |
ID/Acronym/Agency:
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//Department of Health |
| Chemical | |
Reg. No./Substance:
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0/Colloids; 0/Hartman's solution; 0/Isotonic Solutions; 0/Plasma Substitutes; 0/Vasoconstrictor Agents; 0/crystalloid solutions; 124-38-9/Carbon Dioxide; 299-42-3/Ephedrine; 7782-44-7/Oxygen; 89-83-8/Thymol; 9005-27-0/Hetastarch |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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