Published Jan 10, 2019

Shiqin Xu

Qingsong Zhao

Fuzhou Wang

Haibo Wu

Wei Wang

Dongying Fu

Yusheng Liu

Xian Wang

Fan Xia

Shanwu Feng

Xiaofeng Shen  


Background: Neuraxial anesthesia-associated maternal hypotension in cesarean delivery is the most frequent and troublesome complication poses serious risks to mother and compromises neonatal well-being. The use of intravenous fluid loading as the preventive strategy in this context has been challenged because inconsistent results cause doubt on its real efficacy. We compared hypotension-preventing effect of crystalloid and colloid with different loading regimens given in a volume-escalation manner in neuraxial anesthetized cesarean parturients.

Methods: One thousand parturients with American Society of Anesthesiologists (ASA) physical status I/II undergoing selective cesarean delivery were screened and 939 were assigned into different fluid loading regimens with a multi-stage randomization. The volume of crystalloid or colloid in each loading regimen was determined by an up-and-down sequential method. Rate of hypotension was recorded as the primary outcome, and the median (EV50) and 90% effective volumes (EV90) of fluids were calculated in epidural and spinal blockades.

Results: A total of 469 subjects were analyzed in the crystalloid group and 470 in the colloid group. The numbers of patients developed clinically significant and severe hypotension are significantly decreased, and the effective volume of colloid required in preventing hypotension in both anesthetized populations is relatively lower than that of crystalloid on the intention-to-treat analyses. There is still an occurrence of hypotension at a rate of about 10%-20% even when the EV90 was reached.

Conclusions: Fluid loading is an effective maneuver in balancing maternal circulation when reaching the effective volume of different neuraxial anesthesia, but prophylactic or therapeutic vasoconstrictors should also be prepared and be given at an appropriate time because a significant proportion of women can still develop hypotension.

Clinical Trial Registration: This trial is registered with ClinicalTrials.gov identifier: NCT01013090.



Cesarean Section, Fluid Therapy, Neuraxial Anesthesia, Hemodynamic, Outcomes

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How to Cite
Xu, S., Zhao, Q., Wang, F., Wu, H., Wang, W., Fu, D., Liu, Y., Wang, X., Xia, F., Feng, S., & Shen, X. (2019). Crystalloid versus Colloid in Stabilizing Hemodynamic of Patients Undergoing Cesarean Section with Neuraxial Anesthesia A Randomized Controlled Trial. Science Insights, 2019(1), 1–13. https://doi.org/10.15354/si.19.ar009
Original Article