Effect of preload <b><i>versus</i></b> coload on reducing the incidence of spinal anesthesia-induced hypotension during cesarean section: a Meta-analysis _West China Medical Journal

Authors：

ZHOU Wenqin , NI Juan ,  MA Yushan , LI Shuying , JIANG Xiaoqin

Department of Anesthesiology, West China Second University Hospital, Sichuan University/Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

MA Yushan, Email: mayushan_123@163.com

Keywords：

Preloading; Coloading; Cesarean section; Hypotension; Spinal anesthesia; Meta-analysis; Systematic review; Randomized controlled trial

DOI：

10.7507/1002-0179.201803186

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ObjectiveTo evaluate the effect of different rehydration strategies on the incidence of spinal anesthesia-induced hypotension and neonatal outcomes during elective cesarean section.MethodsWe searched PubMed, Embase, the Cochran Library, China National Knowledge Internet, VIP database, Wanfang database, and China Biology Medicine database from inception to January 2018, to collect randomized controlled trials (RCTs) about the incidence of spinal anesthesia-induced hypotension during elective cesarean section and neonatal outcomes of preloading or coloading. Two researchers independently screened the literature, extracted data, and evaluated the risk of bias in the study. Meta-analysis was conducted using RevMan 5.3 software.ResultsA total of 11 RCTs were included, including 894 parturients, of whom 448 cases in the preload group and 446 cases in the coload group. Comparing with the preload group, the incidence of spinal anesthesia-induced hypotension during cesarean section in the coload group significantly decreased [risk ratio (RR)=1.27, 95% confidence interval (CI) (1.13, 1.43), P<0.000 1]. Subgroup analysis showed that in the crystalloid fluid group, the difference in the incidence of hypotension between the preload group and the coload group was statistically significant [RR=1.48, 95%CI (1.26, 1.73), P<0.000 01]; while in the colloidal fluid group, the difference in the the incidence of hypotension between the preload group and the coload group was not significant [RR=1.00, 95%CI (0.85, 1.17), P=0.96]. The lowest systolic blood pressure, the incidence of nausea and vomiting, and neonatal outcomes had no significant difference between the two groups.ConclusionsComparing with preloading crystalloid fluid, rapid infusion of crystalloid fluid at the same time implementation of spinal anesthesia could significantly reduce the incidence of hypotension during cesarean section while there was no superiority in infusion of colloid fluid. There was no significant effect on the severity of hypotension, nausea and vomiting, and neonatal outcomes. Due to the limitation of the quantity and quality of the included studies, the above conclusions need to be verified by more high-quality studies.

Citation： ZHOU Wenqin, NI Juan, MA Yushan, LI Shuying, JIANG Xiaoqin. Effect of preload versus coload on reducing the incidence of spinal anesthesia-induced hypotension during cesarean section: a Meta-analysis . West China Medical Journal, 2018, 33(5): 561-568. doi: 10.7507/1002-0179.201803186 Copy

1.	Griffiths JD, Gyte GM, Paranjothy S, et al. Interventions for preventing nausea and vomiting in women undergoing regional anaesthesia for caesarean section. Cochrane Database Syst Rev, 2012(9): CD007579.
2.	Emmett RS, Cyna AM, Andrew M, et al. Techniques for preventing hypotension during spinal anaesthesia for caesarean section. Cochrane Database Syst Rev, 2002(3): CD002251.
3.	Ngan Kee WD. Prevention of maternal hypotension after regional anaesthesia for caesarean section. Curr Opin Anaesthesiol, 2010, 23(3): 304-309.
4.	Carpenter RL, Caplan RA, Brown DL, et al. Incidence and risk factors for side effects of spinal anesthesia. Anesthesiology, 1992, 76(6): 906-916.
5.	Golparvar M, Saghaei M, Saadati MA, et al. Effect of ondansetron on prevention of post-induction hypotension in elderly patients undergoing general anesthesia: a randomized, double-blind placebo-controlled clinical trial. Saudi J Anaesth, 9(4): 365-369.
6.	Marashi SM, Soltani-Omid S, Soltani Mohammadi S, et al. Comparing two different doses of intravenous ondansetron with placebo on attenuation of spinal-induced hypotension and shivering. Anesthesiol Pain Med, 2014, 4(2): e12055.
7.	Wollman SB, Marx GF. Acute hydration for prevention of hypotension of spinal anesthesia in parturients. Anesthesiology, 1968, 29(2): 374-380.
8.	Rout CC, Rocke DA, Levin J, et al. A reevaluation of the role of crystalloid preload in the prevention of hypotension associated with spinal anesthesia for elective cesarean section. Anesthesiology, 1993, 79(2): 262-269.
9.	Dyer RA, Farina Z, Joubert IA, et al. Crystalloid preload versus rapid crystalloid administration after induction of spinal anaesthesia (coload) for elective caesarean section. Anaesth Intensive Care, 2004, 32(3): 351-357.
10.	Oh AY, Hwang JW, Song IA, et al. Influence of the timing of administration of crystalloid on maternal hypotension during spinal anesthesia for cesarean delivery: preload versus coload. BMC Anesthesiol, 2014, 14(1): 36.
11.	Farid Z, Mushtaq R, Ashraf S, et al. Comparative efficacy of crystalloid preloading and co-loading to prevent spinal anesthesia induced hypotension in elective caesarean section. Pakistan J Med Health Sci, 2016, 10(1): 42-45.
12.	Carvalho B, Mercier FJ, Riley ET, et al. Hetastarch co-loading is as effective as pre-loading for the prevention of hypotension following spinal anesthesia for cesarean delivery. Int J Obstet Anesth, 2009, 18(2): 150-155.
13.	Siddik-Sayyid SM, Nasr VG, Taha SK, et al. A randomized trial comparing colloid preload to coload during spinal anesthesia for elective cesarean delivery. Anesth Analg, 2009, 109(4): 1219-1224.
14.	Williams A, Afzal L, Jacob J, et al. Crystalloid preload versus crystalloid coload for parturients undergoing cesarean section under spinal anesthesia. J Obstet Anaesth Crit Care, 2012, 2(1): 10.
15.	Sharma A, Gupta PK, Singh SN, et al. Crystalloid prehydration versus cohydration for prevention of hypotension during spinal anaesthesia for elective caesarean section. Health Renaissance, 2014, 12(3): 190-196.
16.	Teoh WH, Sia AT. Colloid preload versus coload for spinal anesthesia for cesarean delivery: the effects on maternal cardiac output. Anesth Analg, 2009, 108(5): 1592-1598.
17.	Khan M, WaqarulNisai, Farooqi A, et al. Crystalloid co-load: a Better Option Than Crystalloid Pre-Load For Prevention Of Postspinal Hypotension In Elective Caesarean Section. Int J Anesthesiol, 2013, 32(1): 1-8.
18.	Nishikawa K, Yokoyama N, Saito S, et al. Comparison of effects of rapid colloid loading before and after spinal anesthesia on maternal hemodynamics and neonatal outcomes in cesarean section. J Clin Monit Comput, 2007, 21(2): 125-129.
19.	Varshney RK, Kapoor K. A randomised prospective double blind study to compare the effects of fluid preloading and co-loading during spinal anaesthesia for caesarean delivery. Ann Int Med Dent Res, 2016, 2(1): 410-414.
20.	Kulkarni AG, Asai O, Tarkase AS. Comparative evaluation of co-loading versus preloading for prevention of post-spinal hypotension in elective caesarean section. Indian J Clin Anaesth, 2016, 3(3): 340-346.
21.	Marx GF, Cosmi EV, Wollman SB. Biochemical status and clinical condition of mother and infant at cesarean section. Anesth Analg, 1969, 48(6): 986-994.
22.	Rout C, Rocke DA. Spinal hypotension associated with cesarean section: will preload ever work?. Anesthesiology, 1999, 91(6): 1565-1567.
23.	Banerjee A, Stocche RM, Angle P, et al. Preload or coload for spinal anesthesia for elective cesarean delivery: a meta-analysis. Can J Anesth, 2010, 57(1): 24-31.
24.	Bouchnak, Cheikh B, Skhiri, et al. Relevance of rapid crystalloid administration after spinal anaesthesia (coload) in prevention of hypotension during elective caesarean section: A-685. Eur J Anaesthesiol, 2006, 23(3): 592-593.
25.	Cardoso MM, Santos MM, Yamaguchi ET, et al. Fluid preload in obstetric patients. How to do it?. Rev Bras Anestesiol, 2004, 54(1): 13-19.
26.	Ripollés MJ, Espinosa Á, Martínez HE, et al. Colloids versus crystalloids in the prevention of hypotension induced by spinal anesthesia in elective cesarean section. A systematic review and meta-analysis. Minerva Anestesiol, 2015, 81(9): 1019-1030.
27.	Tamilselvan P, Fernando R, Bray J, et al. The effects of crystalloid and colloid preload on cardiac output in the parturient undergoing planned cesarean delivery under spinal anesthesia: a randomized trial. Anesth Analg, 2009, 109(6): 1916-1921.
28.	Ueyama H, He YL, Tanigami H, et al. Effects of crystalloid and colloid preload on blood volume in the parturient undergoing spinal anesthesia for elective cesarean section. Anesthesiology, 1999, 91(6): 1571-1576.
29.	Ogata K, Fukusaki M, Miyako M, et al. The effects of colloid preload on hemodynamics and plasma concentration of atrial natriuretic peptide during spinal anesthesia in elderly patients. Masui, 2003, 52(1): 20-25.
30.	Pouta AM, Karinen J, Vuolteenaho OJ, et al. Effect of intravenous fluid preload on vasoactive peptide secretion during caesarean section under spinal anaesthesia. Anaesthesia, 1996, 51(2): 128-132.
31.	Suga S, Nakao K, Itoh H, et al. Endothelial production of C-type natriuretic peptide and its marked augmentation by transforming growth factor-beta. Possible existence of " vascular natriuretic peptide system”. J Clin Invest, 1992, 90(3): 1145-1149.
32.	Kamenik M, Paver-Erzen V. The effects of lactated Ringer’s solution infusion on cardiac output changes after spinal anesthesia. Anesth Analg, 2001, 92(3): 710-714.
33.	Hahn RG, Svensén C. Plasma dilution and the rate of infusion of Ringer’s solution. Br J Anaesth, 1997, 79(1): 64-67.
34.	Khooshideh M, Heidari MH. Comparison of the hemodynamic effects of pretreatment with crystalloids versus crystalloids plus ephedrine during spinal anesthesia for caesarean section. Shiraz E Med J, 2009(10): 59-65.
35.	Gunusen I, Karaman S, Ertugrul V, et al. Effects of fluid preload (crystalloid or colloid) compared with crystalloid co-load plus ephedrine infusion on hypotension and neonatal outcome during spinal anaesthesia for caesarean delivery. Anaesth Intensive Care, 2010, 38(4): 647-653.

1. Griffiths JD, Gyte GM, Paranjothy S, et al. Interventions for preventing nausea and vomiting in women undergoing regional anaesthesia for caesarean section. Cochrane Database Syst Rev, 2012(9): CD007579.
2. Emmett RS, Cyna AM, Andrew M, et al. Techniques for preventing hypotension during spinal anaesthesia for caesarean section. Cochrane Database Syst Rev, 2002(3): CD002251.
3. Ngan Kee WD. Prevention of maternal hypotension after regional anaesthesia for caesarean section. Curr Opin Anaesthesiol, 2010, 23(3): 304-309.
4. Carpenter RL, Caplan RA, Brown DL, et al. Incidence and risk factors for side effects of spinal anesthesia. Anesthesiology, 1992, 76(6): 906-916.
5. Golparvar M, Saghaei M, Saadati MA, et al. Effect of ondansetron on prevention of post-induction hypotension in elderly patients undergoing general anesthesia: a randomized, double-blind placebo-controlled clinical trial. Saudi J Anaesth, 9(4): 365-369.
6. Marashi SM, Soltani-Omid S, Soltani Mohammadi S, et al. Comparing two different doses of intravenous ondansetron with placebo on attenuation of spinal-induced hypotension and shivering. Anesthesiol Pain Med, 2014, 4(2): e12055.
7. Wollman SB, Marx GF. Acute hydration for prevention of hypotension of spinal anesthesia in parturients. Anesthesiology, 1968, 29(2): 374-380.
8. Rout CC, Rocke DA, Levin J, et al. A reevaluation of the role of crystalloid preload in the prevention of hypotension associated with spinal anesthesia for elective cesarean section. Anesthesiology, 1993, 79(2): 262-269.
9. Dyer RA, Farina Z, Joubert IA, et al. Crystalloid preload versus rapid crystalloid administration after induction of spinal anaesthesia (coload) for elective caesarean section. Anaesth Intensive Care, 2004, 32(3): 351-357.
10. Oh AY, Hwang JW, Song IA, et al. Influence of the timing of administration of crystalloid on maternal hypotension during spinal anesthesia for cesarean delivery: preload versus coload. BMC Anesthesiol, 2014, 14(1): 36.
11. Farid Z, Mushtaq R, Ashraf S, et al. Comparative efficacy of crystalloid preloading and co-loading to prevent spinal anesthesia induced hypotension in elective caesarean section. Pakistan J Med Health Sci, 2016, 10(1): 42-45.
12. Carvalho B, Mercier FJ, Riley ET, et al. Hetastarch co-loading is as effective as pre-loading for the prevention of hypotension following spinal anesthesia for cesarean delivery. Int J Obstet Anesth, 2009, 18(2): 150-155.
13. Siddik-Sayyid SM, Nasr VG, Taha SK, et al. A randomized trial comparing colloid preload to coload during spinal anesthesia for elective cesarean delivery. Anesth Analg, 2009, 109(4): 1219-1224.
14. Williams A, Afzal L, Jacob J, et al. Crystalloid preload versus crystalloid coload for parturients undergoing cesarean section under spinal anesthesia. J Obstet Anaesth Crit Care, 2012, 2(1): 10.
15. Sharma A, Gupta PK, Singh SN, et al. Crystalloid prehydration versus cohydration for prevention of hypotension during spinal anaesthesia for elective caesarean section. Health Renaissance, 2014, 12(3): 190-196.
16. Teoh WH, Sia AT. Colloid preload versus coload for spinal anesthesia for cesarean delivery: the effects on maternal cardiac output. Anesth Analg, 2009, 108(5): 1592-1598.
17. Khan M, WaqarulNisai, Farooqi A, et al. Crystalloid co-load: a Better Option Than Crystalloid Pre-Load For Prevention Of Postspinal Hypotension In Elective Caesarean Section. Int J Anesthesiol, 2013, 32(1): 1-8.
18. Nishikawa K, Yokoyama N, Saito S, et al. Comparison of effects of rapid colloid loading before and after spinal anesthesia on maternal hemodynamics and neonatal outcomes in cesarean section. J Clin Monit Comput, 2007, 21(2): 125-129.
19. Varshney RK, Kapoor K. A randomised prospective double blind study to compare the effects of fluid preloading and co-loading during spinal anaesthesia for caesarean delivery. Ann Int Med Dent Res, 2016, 2(1): 410-414.
20. Kulkarni AG, Asai O, Tarkase AS. Comparative evaluation of co-loading versus preloading for prevention of post-spinal hypotension in elective caesarean section. Indian J Clin Anaesth, 2016, 3(3): 340-346.
21. Marx GF, Cosmi EV, Wollman SB. Biochemical status and clinical condition of mother and infant at cesarean section. Anesth Analg, 1969, 48(6): 986-994.
22. Rout C, Rocke DA. Spinal hypotension associated with cesarean section: will preload ever work?. Anesthesiology, 1999, 91(6): 1565-1567.
23. Banerjee A, Stocche RM, Angle P, et al. Preload or coload for spinal anesthesia for elective cesarean delivery: a meta-analysis. Can J Anesth, 2010, 57(1): 24-31.
24. Bouchnak, Cheikh B, Skhiri, et al. Relevance of rapid crystalloid administration after spinal anaesthesia (coload) in prevention of hypotension during elective caesarean section: A-685. Eur J Anaesthesiol, 2006, 23(3): 592-593.
25. Cardoso MM, Santos MM, Yamaguchi ET, et al. Fluid preload in obstetric patients. How to do it?. Rev Bras Anestesiol, 2004, 54(1): 13-19.
26. Ripollés MJ, Espinosa Á, Martínez HE, et al. Colloids versus crystalloids in the prevention of hypotension induced by spinal anesthesia in elective cesarean section. A systematic review and meta-analysis. Minerva Anestesiol, 2015, 81(9): 1019-1030.
27. Tamilselvan P, Fernando R, Bray J, et al. The effects of crystalloid and colloid preload on cardiac output in the parturient undergoing planned cesarean delivery under spinal anesthesia: a randomized trial. Anesth Analg, 2009, 109(6): 1916-1921.
28. Ueyama H, He YL, Tanigami H, et al. Effects of crystalloid and colloid preload on blood volume in the parturient undergoing spinal anesthesia for elective cesarean section. Anesthesiology, 1999, 91(6): 1571-1576.
29. Ogata K, Fukusaki M, Miyako M, et al. The effects of colloid preload on hemodynamics and plasma concentration of atrial natriuretic peptide during spinal anesthesia in elderly patients. Masui, 2003, 52(1): 20-25.
30. Pouta AM, Karinen J, Vuolteenaho OJ, et al. Effect of intravenous fluid preload on vasoactive peptide secretion during caesarean section under spinal anaesthesia. Anaesthesia, 1996, 51(2): 128-132.
31. Suga S, Nakao K, Itoh H, et al. Endothelial production of C-type natriuretic peptide and its marked augmentation by transforming growth factor-beta. Possible existence of " vascular natriuretic peptide system”. J Clin Invest, 1992, 90(3): 1145-1149.
32. Kamenik M, Paver-Erzen V. The effects of lactated Ringer’s solution infusion on cardiac output changes after spinal anesthesia. Anesth Analg, 2001, 92(3): 710-714.
33. Hahn RG, Svensén C. Plasma dilution and the rate of infusion of Ringer’s solution. Br J Anaesth, 1997, 79(1): 64-67.
34. Khooshideh M, Heidari MH. Comparison of the hemodynamic effects of pretreatment with crystalloids versus crystalloids plus ephedrine during spinal anesthesia for caesarean section. Shiraz E Med J, 2009(10): 59-65.
35. Gunusen I, Karaman S, Ertugrul V, et al. Effects of fluid preload (crystalloid or colloid) compared with crystalloid co-load plus ephedrine infusion on hypotension and neonatal outcome during spinal anaesthesia for caesarean delivery. Anaesth Intensive Care, 2010, 38(4): 647-653.

West China Medical Journal

Effect of preload versus coload on reducing the incidence of spinal anesthesia-induced hypotension during cesarean section: a Meta-analysis

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