Is crystalloid co-loading necessary to prevent spinal hypotension during elective cesarean delivery? A randomized double-blind trial

In recent years, our understanding of the physiologic changes in pregnant women undergoing elective cesarean delivery under spinal anesthesia has evolved and the management of spinal hypotension has changed. An outstanding question that remains unresolved is the need for crystalloid co-loading for spinal anesthesia, especially with the current practice of prophylactic phenylephrine infusion. While maintaining cardiac output (CO) is important for adequate uterine perfusion,1 we also know that excessive intravenous fluids can lead to increased cardiovascular work and even pulmonary edema in susceptible pregnant women, such as pregnant women receiving tocolysis, magnesium or with a reduced ejection fraction.
Source: International Journal of Obstetric Anesthesia - Category: Anesthesiology Authors: Tags: Original Article Source Type: research