Preloading versus Coloading with Crystalloids for Preventing Hypotension during Spinal Anesthesia for Cesarean Sections in Resource-limited Settings
DOI:
https://doi.org/10.3329/mediscope.v13i1.87093Keywords:
Hypotension, Subarachnoid block, Cesarean sections, Preload, Coload, CrystalloidsAbstract
Background: Maternal hypotension often occurs during spinal anesthesia for cesarean delivery and can be risky for both mother and fetus. Crystalloids are commonly used to prevent this, but it remains unclear whether giving them before anesthesia (preload) or during anesthesia (coload) is more effective. This study compares the effectiveness of preload versus coload crystalloid administration for preventing hypotension during spinal anesthesia for cesarean sections.
Methods: This prospective, controlled clinical trial was conducted at Gazi Medical College, Khulna, Bangladesh, from July 2024 to December 2024. The study enrolled a total of 200 ASA Grade I-III parturients undergoing elective cesarean delivery under spinal anesthesia. Participants were randomly divided into two groups: preload (n=100) and coload (n=100) using an odd-even method based on the enrollment sequence. Intravenous crystalloids were administered before or immediately after spinal anesthesia, respectively. Standard monitoring and spinal anesthesia procedures were followed. Statistical analysis was performed using SPSS v26.0, and a p-value <0.05 was considered statistically significant.
Results: Some baseline characteristics showed statistical differences but were not considered clinically meaningful. Hemodynamic parameters were monitored at several intervals post-spinal anesthesia. Heart rate initially increased, peaking at 5 minutes, then gradually declined. The maximum SBP drop at 5 minutes was significantly greater in the preload group (p <0.001). DBP also decreased notably at 10 minutes (p <0.001). MAP was significantly higher in the coload group at 10 minutes (p <0.001). Hypotension occurred less frequently in the coload group (57% vs. 86%, p <0.001), indicating greater coloading effectiveness in preventing hypotension during cesarean section under subarachnoid block (SAB).
Conclusion: Coloading with crystalloids during spinal anesthesia (SAB) for cesarean sections is a more effective approach than preloading in preventing maternal hypotension, particularly in resource-limited settings. Due to its simplicity and practicality, coloading is a cost-effective strategy for managing anesthesia in obstetric care.
Mediscope 2026;13(1): 01-07
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Copyright (c) 2026 Abhijit Mondol, Gaitri Kashyapi, S. M. Ikbal Kabir, Md. Farhan Azad, Morsheda Yasmin Tamanna
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