A Comparative Evaluation of Pre-loading and Co- Loading of Crystalloid in Determining the Incidence of Hypotension in Parturients Undergoing Caesarean Section Under Spinal Anaesthesia – a Prospective Randomised Comparative Study
Year: 2025
Type: article
Study designs: Randomized Controlled Trial, Clinical Trial
Abstract: Background: Prophylactic fluid pre-loading before spinal anesthesia has been a routine procedure to prevent maternal hypotension during cesarean delivery. Unlike colloid, timing of infusion of crystalloid may be important because of its short stay in intravascular space. We hypothesized that crystalloid loading just after intrathecal injection compared to preload would be more effective in preventing maternal hypotension. Aim: To compare the effect of pre-loading and co-loading of crystalloid in determining the incidence of hypotension in parturients undergoing caesarean delivery under spinal anaesthesia. Methods: A profile of 70 ASA II parturients between age group 18- 40 years and height >150 cm, posted for elective caesarean section in Deen Dayal Upadhyay Hospital, Hari Nagar, New Delhi during the period of May 2022 to June 2024. Patients were randomly allocated into two groups, the Pre-load group and the Co-load group. The Pre-load group received Ringer’s lactate infusion of 15 ml/kg over 20 minutes prior to induction of spinal anaesthesia and the Co-load group received Ringer’s lactate infusion of 15 ml/kg starting with the visualization of free flow of cerebrospinal fluid (CSF) during induction of spinal anaesthesia. The Systolic blood pressure (SBP), Diastolic blood pressure (DBP), Mean blood pressure (MAP), Heart rate (HR) and the incidence of spinal anaesthesia-induced hypotension (defined as a fall in systolic BP >20% of the baseline or <90 mm Hg) including vasopressor requirement and adverse symptoms were recorded at regular intervals of time till the end of surgery. Results: The distribution of hypotension was similar between the Co-load and Pre-load groups. Hypotension was absent in 37.14% of the Co-load group compared to 28.57% in the Pre-load group. Conversely, hypotension was present in 62.86% of the Co-load group and 71.43% of the Pre-load group. The p value for this comparison is 0.445, indicating no significant difference between the two groups. Most participants in both groups did not need vasopressors, and there were no significant differences observed. Conclusion: We conclude that neither preload, nor co-load method of crystalloid administration was able to completely prevent occurrence of hypotension after giving spinal anaesthesia, in obstetric patients. Further, hydration only is not sufficient for prevention of spinal anaesthesia induced hypotension and vasopressor should always be prepared and readily administered when indicated.
DOI: 10.53555/wh30jm80
Author: Dr. Vedanshi Singh
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: gold
OpenAlex ID: W4408537914