Article Text

Download PDFPDF

B277 Norepinephrine infusion for prevention of maternal hypotension. Which fluids and when?
  1. K Theodoraki1,
  2. S Hadzilia2,
  3. D Valsamidis2,
  4. K Kalopita2 and
  5. E Stamatakis2
  1. 1Aretaieion University Hospital, National and Kapodistrian University of Athens, Athens, Greece
  2. 2 , Alexandra General Hospital of Athens, Athens, Greece


Background and Aims The aim of this randomized study was to investigate the combination of a norepinephrine infusion and colloid preloading versus the combination of a norepinephrine infusion and crystalloid co-loading for the prevention of maternal hypotension during elective cesarean section under combined spinal-epidural anaesthesia

Methods After Ethics Committee approval, one hundred parturients were randomized to receive either 6% hydroxyethyl starch 5 mL/kg before spinal anesthesia (colloid preload) or Ringer’s Lactate solution 10 mL/kg starting with intrathecal injection (crystalloid co-load). Both groups were also administered norepinephrine 4 μg/min, starting simultaneously with the administration of the subarachnoid solution. The primary outcome was the incidence of maternal hypotension (SBP<80% of baseline). The incidence of severe hypotension (SBP<80 mmHg), total dose of ephedrine administered as well as maternal side-effects and the neonatal outcome were also recorded

Results There were no significant differences in the incidence of hypotension (13.7% vs. 16.3%, p=0.933 or severe hypotension (0% vs. 4%, P=0.238) between colloid preload and crystalloid co-load groups, respectively. The median [range] ephedrine dose was also comparable between the two groups (P=0.807). There were no significant differences in maternal side-effects or neonatal outcomes between groups

Conclusions The incidence of hypotension during elective cesarean section is low and comparable when a norepinephrine infusion is used in combination with either colloid preload or crystalloid co-load, with perhaps a marginal superiority of colloid preload in the prevention of severe hypotension. It appears that the optimal regimen for prevention of maternal hypotension is a combination of fluids and a prophylactic vasopressor like norepinephrine

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.