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OBSTETRIC ANESTHESIOLOGY

Colloid Preload Versus Coload for Spinal Anesthesia for Cesarean Delivery: The Effects on Maternal Cardiac Output

From the Department of Women’s Anesthesia, KK Women’s and Children’s Hospital, Singapore.

Address correspondence and reprint requests to Dr. Wendy H.L. Teoh, Department of Women’s Anesthesia, KK Women’s and Children’s Hospital, 100 Bukit Timah Rd., Singapore 229899. Address e-mail to teohwendy{at}yahoo.com.

Abstract

BACKGROUND: Spinal anesthesia for cesarean delivery may cause severe maternal hypotension, and a decrease in cardiac output (CO) and blood flow to the placenta. Fluid preloading with crystalloid is ineffective due to rapid redistribution. A "coload" given at the time of cerebrospinal fluid identification may be more effective. Our null hypothesis was that there would be no difference between the effect of a colloid preload (15 mL/kg hydroxyethyl starch (HES) 130/0.4 [Voluven® 6%]) and an identical coload on maternal CO and the incidence of hypotension after spinal anesthesia for cesarean delivery. Secondary outcomes studied were neonatal acid- base status and predelivery vasopressor requirements.

METHODS: Forty ASA PS I and II women scheduled for elective cesarean delivery were recruited. Patients were randomized to Group P (preload of 15 mL/kg HES) or Group C (coload, given when cerebrospinal fluid identified). Heart rate, arterial blood pressure, stroke volume and CO measurements were recorded at baseline, every minute for 10 min, and every 2.5 min interval for 10 min with the USCOM^TM ultrasonic CO monitor. Spinal anesthesia was performed at the L3/4 interspace in the right lateral position. Arterial blood pressure was maintained at 90%–100% of baseline values using IV phenylephrine boluses.

RESULTS: Demographic, anesthetic, and surgical characteristics were similar. There were no between-group differences in baseline systolic blood pressure, heart rate, and colloid volume. CO and stroke volume were significantly increased in Group P (P = 0.01) in the 5 min after spinal anesthesia. This increase in CO was not sustained at 10 min. There were no significant between-group differences in the incidence of hypotension, absolute arterial blood pressure values (P = 0.73), predelivery median (range) phenylephrine requirements (300[0–1000] in Group P versus 150 [0–850]µg in Group C, P = 0.24), or neonatal outcome as measured by Apgar scores and umbilical arterial and venous blood gas values.

CONCLUSION: Intravascular volume expansion with 15 mL/kg HES 130/0.4 given as a preload, but not coload, significantly increased maternal CO for the first 5 min after spinal anesthesia for cesarean delivery, however, maternal and neonatal outcomes were not different.