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Korean Journal of Anesthesiology 2008;55(6):685-690.
DOI: https://doi.org/10.4097/kjae.2008.55.6.685   
The effect of colloid co-hydration on the use of phenylephrine and hemodynamics during low-dose combined spinal-epidural anesthesia for cesarean delivery.
Suk Young Lee, Duck Hwan Choi, Hyo Won Park
Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. dhchoi@skku.edu
Ephedrine has been recommended as the best vasopressor in obstetrics. But, recent clinical evidences show the possibility that phenylephrine has become more pertinent as a primary vasopressor. We think a phenylephrine infusion with colloid co-hydration will be more useful in maintaining baseline blood pressure in combined spinal-epidural anesthesia (CSEA) for cesarean section.
CSEA was performed using 6 mg bupivacaine and 20microgram fentanyl as a spinal and 10 ml of 0.25% levobupivacaine as an epidural in randomized, colloid co-hydration (hydroxyethl starch, HES 500 ml) (group C, n = 34) or no colloid co-hydration (group N, n=34) parturients scheduled to undergo cesarean delivery. After an infusion of 100microgram phenylephrine following the spinal injection, phenylephrine was intermittently infused using a PCA-pump to maintain the baseline blood pressure (BP). Systolic BP and heart rate (HR) were checked and total phenylephrine amount was measured. Nausea and vomiting and fetal umbilical pH/base excess (BE) were also investigated.
There was a lower incidence of bradycardia in the C group compared with the N group (5.9% vs. 32.4%, p = 0.014), and total phenylephrine consumption was less in the C group (400microgram vs. 500microgram, p = 0.019). The incidence of reactive hypertension (11.8% vs. 55.9%, p < 0.001), and the hypotension (0% vs. 11.8%, p = 0.114) were lower in the C group, too. The others were comparable in both groups.
Colloid co-hydration was effective in reducing the phenylephrine use and the incidences of abnormal hemodynamics such as hypotension, bradycardia and hypertension in low-dose CSEA for cesarean delivery.
Key Words: cesarean section; colloid co-hydration; combined spinal-epidural anesthesia; hypotension; phenylephrine


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