Article Text
Abstract
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