Co-Loading Versus Pre-Loading for Preventing Post-Spinal Hypotension in Caesarean Section

Authors

  • Muhammad Tayyab Saeed Department of Anaesthesia, Combined Military Hospital, Quetta/National University of Medical Sciences (NUMS) Pakistan
  • Ali Rao Department of Anaesthesia, Combined Military Hospital, Multan/ National University of Medical Sciences (NUMS) Pakistan
  • Muhammad Nasir Saeed Department of Anaesthesia, Allied Hospital, Faisalabad Pakistan
  • Tasneem Alam Department of Anaesthesia, Combined Military Hospital, Quetta/National University of Medical Sciences (NUMS) Pakistan
  • Azmat Riaz Department of Anaesthesia, Pak Emirates Military Hospital/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
  • Hira Ahmad Department of Anaesthesia, Tehsil Headquarter Hospital, Gujar Khan Pakistan

DOI:

https://doi.org/10.51253/pafmj.v74i2.8150

Keywords:

Co-loading, Leg Elevation, Post-Spinal Hypotension, Pre-loading

Abstract

Objective: To compare the frequency of post-spinal anaesthesia hypotension occurring with co-loading versus pre-loading in patients undergoing caesarean section.

Study Design: Cross-sectional analytical study.

Place and Duration of Study: Department of Anaesthesiology, Pak-Emirates Military Hospital, Rawalpindi Pakistan, Sep 2020 to Mar 2021.

Methodology: A total of 70 patients undergoing spinal anaesthesia for caesarean section and meeting the sample selection criteria were included. Patients with emergency procedures or a history of blood pressure disorders were excluded. Patients in Group-A underwent co-loading with ringer lactate, while patients in Group-B underwent pre-loading. All participants had their systolic and diastolic blood pressure and mean arterial pressure measured at the time of anaesthesia induction and then at 5, 10, 15, and 30 minutes post anaesthesia induction.

Results: There was difference in mean systolic pressure at 10 and 15 minutes, p=0.001 and p=0.027, respectively. The difference in diastolic blood pressure was only significant at 10 minutes, p=0.001. While, mean arterial pressures were significantly higher at 10 and 15 minutes with co-loading, p<0.001 and p=0.019, respectively.
Conclusion: Co-loading is associated with less frequency of post-spinal hypotension than pre-loading and may be employed as a standard practice pre-operatively with spinal anaesthesia.

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References

Olawin AM, M Das J. Spinal Anesthesia. 2020. In: StatPearls.

Treasure Island (FL): StatPearls Publishing; 2021.

Ring L, Landau R, Delgado C. The Current Role of General

Anesthesia for Cesarean Delivery. Curr Anesthesiol Rep 2021;

(1): 18-27. https://doi.org/10.1007/s40140-021-00437-6

Koo CH, Shin HJ, Han SH, Ryu JH. Lidocaine vs. Other Local

Anesthetics in the Development of Transient Neurologic

Symptoms (TNS) Following Spinal Anesthesia: A Meta-Analysis

of Randomized Controlled Trials. J Clin Med 2020; 9(2): 493.

https://doi.org/10.3390/jcm9020493

Zhang N, He L, Ni JX. Level of sensory block after spinal

anesthesia as a predictor of hypotension in parturient. Medicine

; 96(25): e7184.

https://doi.org/10.1097/md.0000000000007184

Ferré F, Martin C, Bosch L, Kurrek M, Lairez O, Minville V.

Control of spinal anesthesia-induced hypotension in adults. Local

Reg Anesth 2020; 13: 39-46. https://doi.org/10.2147/lra.s240753

Massoth C, Töpel L, Wenk M. Hypotension after spinal

anesthesia for cesarean section: how to approach the iatrogenic

sympathectomy. Curr Opin Anaesthesiol 2020; 33(3): 291-298.

https://doi.org/10.1097/aco.0000000000000848

Alemayehu TY, Berhe YW, Getnet H, Molallign M.

Hemodynamic changes after spinal anesthesia in preeclamptic

patients undergoing cesarean section at a tertiary referral center

in Ethiopia: a prospective cohort study. Patient Saf Surg 2020;

(1): 9. https://doi.org/10.1186/s13037-020-00234-w

Bower JR, Kinsella SM. Preventing and treating hypotension

during spinal anaesthesia for caesarean section. BJA Educ 2020;

(11): 360-361. https://doi.org/10.1016%2Fj.bjae.2020.08.001

Buthelezi AS, Bishop DG, Rodseth RN, Dyer RA. Prophylactic

phenylephrine and fluid co-administration to reduce spinal

hypotension during elective caesarean section in a

resource-limited setting: a prospective alternating intervention

study. Anaesthesia 2020; 75(4): 487-492.

https://doi.org/10.1111/anae.14950

Rijs K, Mercier FJ, Lucas DN, Rossaint R, Klimek M, Heesen M.

Fluid loading therapy to prevent spinal hypotension in women

undergoing elective caesarean section: Network meta-analysis,

trial sequential analysis and meta-regression. Eur J Anaesthesiol

; 37(12): 1126-1142.

https://doi.org/10.1097/EJA.0000000000001371

Artawan IM, Sarim BY, Sagita S, Dedi MA. Comparison the Effect

of Preloading and Coloading with Crystalloid Fluid on the

Incidence of Hypotension after Spinal Anesthesia in Cesarean

Section. Bali J Anaesthesiol 2020; 4(1): 3-7.

http://doi.org/10.4103/BJOA.BJOA_17_19

Kaufner L, Karekla A, Henkelmann A, Welfle S, von Weizsäcker

K, Hellmeyer L, et al. Crystalloid coloading vs. colloid coloading

in elective Caesarean section: postspinal hypotension and

vasopressor consumption, a prospective, observational clinical

trial. J Anesth 2019; 33(1): 40–49.

https://doi.org/10.1007/s00540-018-2581-x

Oh AY, Hwang JW, Song IA, Kim MH, Ryu JH, Park HP, et al.

Influence of the timing of administration of crystalloid on

maternal hypotension during spinal anesthesia for cesarean

delivery: preload versus coload. BMC Anesthesiol 2014: 14: 36.

https://doi.org/10.1186/1471-2253-14-36

Jacob JJ, Williams A, Verghese M, Afzal L. Crystalloid preload

versus crystalloid coload for parturients undergoing cesarean

section under spinal anesthesia. J Obstet Anaesth Crit Care 2012;

(1): 10-15.

Rehmani SJ, Sharif A, Gulrez A. Prevention of hypotension after

spinal anaesthesia in elective caesarean sections. Pak Armed

Forces Med J 2020; 70(4): 1034-1038.

Khan MU, Memon AS, Ishaq M, Aqil M. Preload Versus Coload

and Vasopressor Requirement for the Prevention of Spinal

Anesthesia Induced Hypotension in Non-Obstetric Patients. J

Coll Physicians Surg Pak 2015; 25(12): 851-855.

Reshan RG. Preloading versus coloading of crystalloid fluid to

control hypotension due to spinal anesthesia. Int J Adv Res 2018;

(1): 585-588. http://doi.org/10.21474/IJAR01/6259

Teoh WH, Sia AT. Colloid preload versus coload for spinal

anesthesia for cesarean delivery: the effects on maternal cardiac

output. Anesth Analg 2009; 108(5): 1592-1598.

https://doi.org/10.1213/ane.0b013e31819e016d

Varshney R, Jain G. Comparison of colloid preload versus coload

under low dose spinal anesthesia for cesarean delivery. Anesth

Essays Res 2013; 7(3): 376-380.

https://doi.org/10.4103%2F0259-1162.123248

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Published

29-04-2024

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How to Cite

1.
Saeed MT, Ali Rao, Muhammad Nasir Saeed, Tasneem Alam, Azmat Riaz, Hira Ahmad. Co-Loading Versus Pre-Loading for Preventing Post-Spinal Hypotension in Caesarean Section. Pak Armed Forces Med J [Internet]. 2024 Apr. 29 [cited 2024 Oct. 15];74(2):401-4. Available from: https://pafmj.org/PAFMJ/article/view/8150