title: Comparison of effects of rapid colloid loading before and after spinal anesthesia on maternal hemodynamics and neonatal outcomes in cesarean section.
abstract: BACKGROUND
  The effects of colloid loading after spinal anesthesia on hemodynamics in parturients during cesarean section have not been fully understood. This study tested the hypothesis that colloid loading after spinal blockade can reduce hypotension compared with preloading, and affect neonatal outcomes.
  
  
  METHODS
  A prospective, randomized, double-blinded study was performed in 54 healthy parturients (ASA I or II) undergoing elective cesarean section. Patients were randomly allocated into one of three groups to receive rapid infusion of 6% hydroxyethylstarch (HES) (70 kDa/0.5) before spinal anesthesia (15 ml x kg(-1), HES preload group, n = 18), or rapid infusion of HES after induction of spinal anesthesia (15 ml x kg(-1), HES coload group, n = 18), or no rapid infusion (control, n = 18). The incidence of hypotension, and the amount of ephedrine used to treat hypotension was compared. Neonatal outcomes were also assessed by pH, base excess, lactate concentration, and Apgar scores.
  
  
  RESULTS
  The incidence of hypotension was significantly lower in HES preload and HES coload groups than control group (P < 0.01). Although systolic blood pressure decreased after spinal blockade in all groups, the lowest SBP after spinal blockade until delivery was significantly higher in fluid loading groups than control (P < 0.001). Similarly, total dose of ephedrine to treat hypotension was lower in fluid loading groups (P < 0.001). Umbilical cord pH, umbilical lactate concentration, and the incidence of neonates with Apgar score <7 were similar.
  
  
  CONCLUSIONS
  Colloid loading after induction of spinal anesthesia was similarly effective in reducing hypo- tension compared with preloading in cesarean section.
authors.affiliation: Department of Anesthesiology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi City 371-8511, Japan. nishikaw@med.gunma-u.ac.jp
authors.forename: Koichi
authors.initials: K
authors.lastname: Nishikawa
authors.forename: Naho
authors.initials: N
authors.lastname: Yokoyama
authors.forename: Shigeru
authors.initials: S
authors.lastname: Saito
authors.forename: Fumio
authors.initials: F
authors.lastname: Goto
mesh_terms: D000328:Adult; D000775:Anesthesia, Spinal / Q000009:adverse effects*; D001794:Blood Pressure / Q000187:drug effects; D002585:Cesarean Section / Q000379:methods*; D003102:Colloids / Q000008:administration & dosage*; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007022:Hypotension / Q000209:etiology* / Q000517:prevention & control*; D007231:Infant, Newborn; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000209:etiology* / Q000517:prevention & control*; D011256:Pregnancy Outcome
chemical_list: D003102:Colloids