Phenylephrine infusion for spinal-induced hypotension in elective cesarean delivery: Does preload make a difference?
OBJECTIVE
Patients undergoing elective cesarean delivery (CD) have a high-risk of spinal-induced hypotension (SIH). We hypothesized that a colloid preload would further reduce SIH when compared with a crystalloid preload.


METHODS
Eighty-two healthy parturients undergoing elective CD were included in the study. Patients were randomly assigned to two groups (41 patients in each group) to receive either Lactated Ringer's solution (1500 ml) or hydroxyethyl starch (6% in normal saline, 500 ml) 30 min prior to placement of spinal anesthesia. All patients were treated with a phenylephrine infusion (100 mcg/min), titrated during the study.


RESULTS
There was no statistical difference between groups with regards to the incidence of hypotension (10.8% in the colloid group vs. 27.0% in the crystalloid group, P = 0.12). There was also no difference between groups with respect to bradycardia, APGAR scores, and nausea and vomiting. Significantly less phenylephrine (1077.5 ± 514 mcg) was used in the colloid group than the crystalloid group (1477 ± 591 mcg, P = 0.003).


CONCLUSIONS
The preload with 6% of hydroxyethyl starch before CD might be beneficial for the prevention of SIH.
Department of Anesthesiology, Duke University Medical Center, Durham, USA.
Brandi A
BA
Bottiger
Department of Anesthesiology, Penn State Milton S Hershey Medical Center, PA 17033, USA.
Dmitri S
DS
Bezinover
Department of Anesthesiology, Penn State Milton S Hershey Medical Center, PA 17033, USA.
Berend
B
Mets
Department of Anesthesiology, Penn State Milton S Hershey Medical Center, PA 17033, USA.
Priti G
PG
Dalal
Department of Anesthesiology, Penn State Milton S Hershey Medical Center, PA 17033, USA.
Jansie
J
Prozesky
Department of Maternal Fetal Medicine, Penn State Milton S Hershey Medical Center, PA 17033, USA.
Serdar
S
Ural
Department of Anesthesiology, Penn State Milton S Hershey Medical Center, PA 17033, USA.
Sonia
S
Vaida
Cesarean section; colloid; phenylephrine; preload; spinal anesthesia