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Revista Brasileira de Anestesiologia
Print version ISSN 0034-7094
SHIQIN, Xu et al. The median effective volume of crystalloid in preventing hypotension in patients undergoing cesarean delivery with spinal anesthesia. Rev. Bras. Anestesiol. [online]. 2012, vol.62, n.3, pp.318-324. ISSN 0034-7094. http://dx.doi.org/10.1590/S0034-70942012000300004.
BACKGROUND AND OBJECTIVES: Spinal anesthesia-associated maternal hypotension in Cesarean delivery is the most frequent and troublesome complication, posing serious risks to mothers and compromising neonatal well-being. The effective volume of intravenous crystalloid as the preventive strategy in this context has not been estimated. METHODS: Eighty-five parturients with ASA physical status I/II undergoing elective Cesarean delivery were screened and 67 eligible women were assigned to receive pre-spinal crystalloid loading. Hyperbaric 0.5% bupivacaine 2 mL (10 mg) plus morphine 50 µg was given to all patients. The volume of crystalloid was determined by an up-and-down sequential method. The crystalloid was infused at a rate of 100-150 mL.min-1 prior to the spinal anesthetic injection. The initial volume of crystalloid was 5 mL.kg-1. Volume-effect data were fitted to a sigmoidal maximum efficacy model and the median effective volume (EV50) and corresponding 95% confidence interval (95% CI) were estimated using maximum likelihood estimation and logistic regression with Firth's correction. RESULTS: A total of 67 subjects completed the study and were analyzed. Twenty-eight (41.8%) patients developed hypotension with their systolic blood pressure (SBP) decreasing > 20% of baseline. The EV50 of crystalloid were 12.6 mL.kg-1 (95% CI, 11.6 to 14.8 mL.kg-1). With Firth's correction, the pooled probability of an effective preventive volume of crystalloid at 13 mL.kg-1 was 50.2% (95% CI, 30% to 83.1%). CONCLUSIONS: The estimated EV50 of the preloaded crystalloid required to prevent spinal anesthesia-induced hypotension in a Cesarean section is, approximately, 13 mL.kg-1. However, prophylactic or therapeutic vasoconstrictors should also be prepared and administered at an appropriate time.
Keywords : anesthesia; spinal; cesarean section; isotonic solutions; hypotension [prevention and control].