Obstetric Anesthesia

Anesthesia for Cesarean Delivery

Maternal Cardiac Output Changes After Crystalloid or Colloid Coload Following Spinal Anesthesia for Elective Cesarean Delivery: A Randomized Controlled Trial

McDonald S, Fernando R, Ashpole K, et al (Royal Free Hosp NHS Trust, London, UK; Univ Hosp of South Manchester NHS Foundation Trust, Wythenshawe, Manchester, UK) Anesth Analg 113:803-810, 2011^§

Abstract

Background

Minimizing hypotension associated with spinal anesthesia for cesarean delivery by administration of IV fluids and vasopressors reduces fetal and maternal morbidity. Most studies have concentrated on noninvasive systolic blood pressure (SBP) measurements to evaluate the effect of such regimens. We used a suprasternal Doppler flow technique to measure maternal cardiac output (CO) variables in parturients receiving a phenylephrine infusion combined with the rapid administration of crystalloid or colloid solution at the time of initiation of anesthesia (coload). We hypothesized that a colloid coload compared with a crystalloid coload would produce a larger sustained increase in CO and therefore reduce vasopressor requirements.

Methods

We recruited 60 healthy term women scheduled for elective cesarean delivery under spinal anesthesia for this randomized double-blind study. Baseline heart rate, baseline SBP, and CO variables including stroke volume, corrected flow time, and contractility were recorded in the left lateral tilt position. At the time of spinal injection, subjects were allocated to receive a rapid 1-L coload of either 6% w/v hydroxyethyl starch solution (HES) or Hartmann (crystalloid) solution (HS). A phenylephrine infusion was titrated to maintain maternal baseline SBP. CO was measured at 5-minute intervals for 20 minutes after initiation of spinal anesthesia. The primary outcome, CO, was compared between groups, as were secondary outcomes: phenylephrine dose and maternal hemodynamic and fetal outcome data.

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