The effect of colloid and crystalloid preloading on thromboelastography prior to Cesarean delivery.
OBJECTIVE
Fluid preloading with colloids reduces hypotension after spinal anesthesia for Cesarean delivery more effectively than crystalloids. However, the effects of fluid preloading regimens on coagulation in pregnant patients remain unresolved. The aim of this study was to compare the effects on coagulation of fluid preloading with 6% hydroxyethyl starch (HES) and lactated Ringer's (LR) solution using thromboelastography (TEG) with kaolin-activated whole blood in healthy pregnant patients prior to spinal anesthesia for Cesarean delivery.


METHODS
After obtaining Ethics committee approval, 30 parturients were prospectively randomized prior to spinal anesthesia for elective Cesarean delivery to receive fluid preloading with either 1500 mL LR or 500 mL 6% HES over 30 min. Thromboelastography was performed immediately prior to and after fluid preloading. Standard TEG parameters were analyzed in terms of r time (min), k time (min), alpha angle (degrees) and maximum amplitude (mm).


RESULTS
Group HES had statistically significant longer reaction times (r) and clot formation times (k) after fluid loading compared to baseline values (P < 0.05 respectively), although these post-fluid loading TEG parameters remained within a normal reference range. No significant differences in TEG values were seen after preloading within the LR group.


CONCLUSIONS
Fluid preloading with 500 mL 6% HES in healthy parturients produced mild coagulation effects, as measured with TEG, prior to spinal anesthesia for Cesarean delivery. No significant effects on coagulation with TEG were observed following preloading with 1500 mL LR.
Butwick
Alexander
A
Department of Anesthesia, H3580, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, California 94305, USA.
Carvalho
Brendan
B
D000328:Adult; D000773:Anesthesia, Obstetrical; D000775:Anesthesia, Spinal; D001777:Blood Coagulation / Q000187:drug effects*; D002585:Cesarean Section; D000077324:Crystalloid Solutions; D005260:Female; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000494:pharmacology*; D007022:Hypotension / Q000517:prevention & control; D007552:Isotonic Solutions / Q000494:pharmacology*; D007744:Obstetric Labor Complications; D010952:Plasma Substitutes / Q000494:pharmacology*; D011247:Pregnancy / Q000097:blood; D011446:Prospective Studies; D000077325:Ringer's Lactate; D018709:Statistics, Nonparametric; D013916:Thrombelastography / Q000379:methods*
D000077324:Crystalloid Solutions; D006895:Hydroxyethyl Starch Derivatives; D007552:Isotonic Solutions; D010952:Plasma Substitutes; D000077325:Ringer's Lactate