Colloid Co-load versus Colloid Pre-load in a Parturient Undergoing Caesarean Delivery with Spinal Anesthesia and Its Effects on Maternal Hemodynamics

Abstract

Spinal anesthesia is considered nowadays the ‘’Gold standard “technique for cesarean section, it is often selected due to its rapid, reliable, and profound sensory and motor blockade. In addition it decreases risk of aspiration, failed intubation and maternal mortality when compared with general anesthesia. These effects are more marked in pregnant women having aortocaval compression and decrease in peripheral vascular resistance. Hypotension during spinal anesthesia for cesarean section is a common and troublesome complication, both for the mother and the fetus. It may have consequences on the mother such as nausea, vomiting, fainting, aspiration in addition it will impair uterine blood flow resulting in fetal hypoxia, acidosis and neonatal depression. The risk of hypotension is increased in a parturient due to higher level of block (T4), unique physiologic and anatomic changes of pregnancy and increased susceptibility to the effects of sympathectomy. Several methods have been used in order to prevent hypotension in parturient undergoing cesarean section these include, left uterine displacement, leg wrapping, using lower dose of spinal anesthetic supplemented by an opiate, fluid and vasopressor administration. One of the most commonly used methods to prevent hypotension is the administration of fluids. Fluid infused before or at the time of induction of spinal anesthesia is referred to as ‘’pre-loading” and” co-loading” respectively.