151. A Case Report: Fluid Management for Cesarean Delivery
- Author
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Ngo, Calvin and Ngo, Calvin
- Abstract
Hypotension during cesarean section under spinal anesthesia remains the most frequent complication encountered in obstetric practice. Hypotension can be challenging to manage due to several contributing factors. Intravenous fluid bolus administration is the most common way of preventing and treating hypotension, however, studies show crystalloid proves ineffective in preventing hypotension during cesarean delivery under spinal anesthesia. Evidence shows intravenous colloid fluids control and manage hypotension more effectively than crystalloids. Additionally, co-loading crystalloid and colloid intravenous fluids proves more effective than preloading. Co-loading is the process of administering a fluid bolus immediately after neuraxial anesthesia is given. Co-loading achieves better hemodynamic stability because as the body vasodilates due to sympathetic blockade effect of neuraxial anesthesia preload is reduced, and fluid administration at this time aids in increasing preload when the body requires it most. Crystalloid fluids administered during the preoperative period only stay in the extracellular fluid for about 30 minutes before being distributed throughout the body. By the time of surgical preparation, the preloaded fluids are minimally efficacious. Vasopressors are also used to treat hypotension during spinal anesthesia for cesarean sections. Phenylephrine has been established as the first-line drug over ephedrine due to the risk of ephedrine affecting the placenta and causing an increased risk of fetal acidosis. This is a case report on a 27-year-old multigravida female presenting for cesarean delivery who experienced hypotension despite a fluid bolus prior to spinal anesthesia.
- Published
- 2024