130104 帝王切開の膠質液preload

帝王切開の膠質液preload

2012レビューから

Loubert C

Fluid and vasopressor management for Cesarean delivery under spinal anesthesia: continuing professional development.
Can J Anaesth. 2012;59:604-19.
http://link.springer.com/article/10.1007%2Fs12630-012-9705-9

膠質液のpreloadは晶質液preloadと比較すると低血圧予防と心拍出量維持には有効である。
Morgan PJ, Halpern SH, Tarshis J. The effects of an increase of central blood volume before spinal anesthesia for cesarean delivery: a qualitative systematic review. Anesth Analg 2001; 92:997-1005.http://www.anesthesia-analgesia.org/content/92/4/997.long
Nishikawa K, Yokoyama N, Saito S, Goto F. Comparison of effects of rapid colloid loading before and after spinal anesthesia on maternal hemodynamics and neonatal outcomes in cesarean
section. J Clin Monit Comput 2007; 21: 125-9.http://link.springer.com/article/10.1007%2Fs10877-006-9066-4
Ngan Kee WD, Khaw KS, Lee BB, Ng FF, Wong MM. Randomized controlled study of colloid preload before spinal anaesthesia for caesarean section. Br J Anaesth 2001; 87: 772-4.http://bja.oxfordjournals.org/content/87/5/772.long
Dahlgren G, Granath F, Pregner K, Rosblad PG, Wessel H, Irestedt L. Colloid vs. crystalloid preloading to prevent maternal hypotension during spinal anesthesia for elective cesarean section. Acta Anaesthesiol Scand 2005; 49: 1200-6.http://onlinelibrary.wiley.com/doi/10.1111/j.1399-6576.2005.00730.x/abstract;jsessionid=1FD01ACA60B158B379231A2C4F916B51.d02t03
Ko JS, Kim CS, Cho HS, Choi DH. A randomized trial of crystalloid versus colloid solution for prevention of hypotension
during spinal or low-dose combined spinal-epidural anesthesia for elective cesarean delivery. Int J Obstet Anesth 2007; 16: 8-12.

500mlのhydroxyethyl starchは1000mlの乳酸リンゲル液と比較して低血圧発現、血管収縮薬投与と嘔気嘔吐の頻度を減少させる。Siddik SM, Aouad MT, Kai GE, Sfeir MM, Baraka AS. Hydroxyethylstarch 10% is superior to Ringer’s solution for preloading before spinal anesthesia for cesarean section. Can J Anesth 2000; 47: 616-21.http://link.springer.com/article/10.1007%2FBF03018992

500ml、1000mlのhydroxyethyl starchと1500mlの晶質液のpreloadをsuprasternal Dopplerで比較した。1000mlHES preloadだけが心拍出量が維持された。Tamilselvan P, Fernando R, Bray J, Sodhi M, Columb M. The effects of crystalloid and colloid preload on cardiac output in the parturient undergoing planned cesarean delivery under spinal anesthesia: a randomized trial. Anesth Analg 2009; 109: 1916-21.http://www.anesthesia-analgesia.org/content/109/6/1916.long

HESは投与後30分間血管内にとどまっているが乳酸リンゲル液は28%しか血管内に存在しない。Ueyama H, He YL, Tanigami H, Mashimo T, Yoshiya I. Effects of crystalloid and colloid preload on blood volume in the parturient undergoing spinal anesthesia for elective cesarean section.
Anesthesiology 1999; 91: 1571-6.http://journals.lww.com/anesthesiology/pages/articleviewer.aspx?year=1999&issue=12000&article=00006&type=abstract

膠質液投与でも臨床的に低血圧は高頻度に生じ、血管収縮薬は時に必要である。


よくまとまってる表はここ。
http://sankamasui.blogspot.jp/2013/01/130103-pre-load.html