Comparative Study of Various Fluid Loading Methods for Elective Cesarean Delivery under Spinal Anesthesia in Phramongkutklao Hospital: A Prospective Randomized Controlled Trial
Siriluk Chumnanvej MD1, Sornjane Sakuljane MD1
Affiliation : 1 Department of Anesthesiology and Operating Room, Phramongkutklao Hospital, Bangkok, Thailand
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 (cid:976)luid loading can prevent SA induced systolic hypotension.
Objectives: The present study aimed to compare various (cid:976)luid 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 signi(cid:976)icant 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 signi(cid:976)icant 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
