Background: The most commonly used anesthetic technique in elective cesarean delivery is spinal anesthesia (SA). However, one drawback of SA is the blocked sympathetic system can induce marked reduction in systemic vascular resistance and mean arterial pressure. In addition, intravenous fluid loading can prevent SA induced systolic hypotension.

Objective: The present study aimed to compare various fluid loading methods including preload (P), coload (C) and preload combined with coload (PC), to prevent hypotension after SA. The secondary objective was to determine appropriate doses of ephedrine requirement and Apgar score evaluation.

Materials and Methods: The single blind, randomized, prospective, controlled trial was approved by the IRB. The present study was performed among 153 term pregnant patients undergoing elective cesarean delivery with SA. All patients were randomized in three groups, i.e., P (n = 51), C (n = 51) and PC (n = 51). Under SA, noninvasive blood pressure was recorded every minute until delivery. Hypotension was treated with ephedrine intravenously and crystalloid boluses. Apgar scores were recorded at 1 and 5 minutes after delivery.

Results: No significant difference was observed between the groups regarding the incidence of hypotension (P = 66.7%, C = 60.8% and PC = 74.5%, p=0.333). The median time to hypotension was 4 minutes (p=0.619). No significant differences were found in dose of ephedrine (p=0.636) and Apgar score (p=0.302, 0.072 at 1 and 5 minutes) among groups.

Conclusion: No difference was observed in the incidence of hypotension in all patients receiving any timing crystalloid intravenous loading after SA for cesarean delivery.

Keywords: Fluid loading, Spinal anesthesia