Crystalloid coloading vs. colloid coloading in elective Caesarean section: postspinal hypotension and vasopressor consumption, a prospective, observational clinical trial.
Adult
Anesthesia, Obstetrical
/ methods
Anesthesia, Spinal
/ methods
Apgar Score
Bradycardia
/ epidemiology
Cesarean Section
/ methods
Colloids
/ administration & dosage
Crystalloid Solutions
/ administration & dosage
Female
Heart Rate
/ drug effects
Humans
Hydroxyethyl Starch Derivatives
/ therapeutic use
Hypotension
/ epidemiology
Incidence
Infant, Newborn
Male
Phenylephrine
/ therapeutic use
Pregnancy
Prospective Studies
Vasoconstrictor Agents
/ administration & dosage
Caesarean section
Colloids
Coloading
Crystalloids
Hypotension
Spinal anaesthesia
Journal
Journal of anesthesia
ISSN: 1438-8359
Titre abrégé: J Anesth
Pays: Japan
ID NLM: 8905667
Informations de publication
Date de publication:
02 2019
02 2019
Historique:
received:
17
07
2018
accepted:
06
11
2018
pubmed:
14
12
2018
medline:
18
2
2020
entrez:
8
12
2018
Statut:
ppublish
Résumé
Maternal hypotension is a common side effect of spinal anaesthesia for Caesarean section. The combination of colloid coloading and vasopressors was considered our standard for its prevention and treatment. As the safety of hydroxyethyl starch is under debate, we replaced colloid with crystalloid coloading. We hypothesize that the mean blood pressure drop is greater when coloading with crystalloids. Prospective, observational clinical trial. Two-centre study conducted in Berlin, Germany. Parturients scheduled for a Caesarean section were screened for eligibility. The study protocol and patient monitoring were based on the standard operating procedure for Caesarean section in both centres. The data from the crystalloid group were prospectively collected between November 2014 and July 2015. The primary endpoint was the median drop in mean blood pressure after induction of spinal anaesthesia. Secondary endpoints were incidence of hypotension (drop > 20% of baseline systolic pressure /drop < 100 mmHg), vasopressor and additional fluid requirements (mL), incidence of bradycardia (heart rate < 60 beats per minute), blood loss, Apgar score, and umbilical artery pH. In case of hypotension, patients received phenylephrine or cafedrine/theodrenaline according to their heart rate. A p < 0.05 was considered significant. 345 prospectively enrolled patients (n = 193 crystalloid group vs. n = 152 colloid group) were analysed. The median drop in mean blood pressure was greater in the crystalloid group [34 mmHg (25; 42 mmHg) vs. 21 mmHg (13; 29 mmHg), p < 0.001]. Incidences of hypotension [93.3% vs. 83.6%, p: 0.004] and bradycardia [19.7% vs. 9.9%, p: 0.012] were also significantly greater in the crystalloid group. Vasopressor requirements, blood loss and neonatal outcome were not different between the groups. Crystalloid coloading was associated with a greater drop in mean blood pressure and a higher incidence of hypotension when compared with colloid coloading. Neonatal outcome was, however, unaffected by the type of fluid. DRKS00006783 ( http://www.drks.de ).
Sections du résumé
BACKGROUND
Maternal hypotension is a common side effect of spinal anaesthesia for Caesarean section. The combination of colloid coloading and vasopressors was considered our standard for its prevention and treatment. As the safety of hydroxyethyl starch is under debate, we replaced colloid with crystalloid coloading.
OBJECTIVE
We hypothesize that the mean blood pressure drop is greater when coloading with crystalloids.
DESIGN
Prospective, observational clinical trial.
SETTING
Two-centre study conducted in Berlin, Germany.
PATIENTS
Parturients scheduled for a Caesarean section were screened for eligibility.
INTERVENTION
The study protocol and patient monitoring were based on the standard operating procedure for Caesarean section in both centres. The data from the crystalloid group were prospectively collected between November 2014 and July 2015.
MAIN OUTCOME MEASURES
The primary endpoint was the median drop in mean blood pressure after induction of spinal anaesthesia. Secondary endpoints were incidence of hypotension (drop > 20% of baseline systolic pressure /drop < 100 mmHg), vasopressor and additional fluid requirements (mL), incidence of bradycardia (heart rate < 60 beats per minute), blood loss, Apgar score, and umbilical artery pH. In case of hypotension, patients received phenylephrine or cafedrine/theodrenaline according to their heart rate. A p < 0.05 was considered significant.
RESULTS
345 prospectively enrolled patients (n = 193 crystalloid group vs. n = 152 colloid group) were analysed. The median drop in mean blood pressure was greater in the crystalloid group [34 mmHg (25; 42 mmHg) vs. 21 mmHg (13; 29 mmHg), p < 0.001]. Incidences of hypotension [93.3% vs. 83.6%, p: 0.004] and bradycardia [19.7% vs. 9.9%, p: 0.012] were also significantly greater in the crystalloid group. Vasopressor requirements, blood loss and neonatal outcome were not different between the groups.
CONCLUSIONS
Crystalloid coloading was associated with a greater drop in mean blood pressure and a higher incidence of hypotension when compared with colloid coloading. Neonatal outcome was, however, unaffected by the type of fluid.
TRIAL REGISTRATION
DRKS00006783 ( http://www.drks.de ).
Identifiants
pubmed: 30523408
doi: 10.1007/s00540-018-2581-x
pii: 10.1007/s00540-018-2581-x
doi:
Substances chimiques
Colloids
0
Crystalloid Solutions
0
Hydroxyethyl Starch Derivatives
0
Vasoconstrictor Agents
0
Phenylephrine
1WS297W6MV
Banques de données
DRKS
['DRKS00006783']
Types de publication
Comparative Study
Journal Article
Multicenter Study
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
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