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The effect of colloid and crystalloid preloading on thromboelastography prior to Cesarean delivery

[L’effet d’une précharge avec un colloïde ou un cristalloïde sur le thromboélastogramme avant l’accouchement par césarienne]

From the Department of Anesthesia, Stanford University School of Medicine, Stanford, California, USA.

Address correspondence to: Dr. Brendan Carvalho, Department of Anesthesia, H3580, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, California 94305, USA. Fax: 650-725-8544; E-mail: bcarvalho{at}stanford.edu

Purpose: Fluid preloading with colloids reduces hypotension after spinal anesthesia for Cesarean delivery more effectively than crystalloids. However, the effects of fluid preloading regimens on coagulation in pregnant patients remain unresolved. The aim of this study was to compare the effects on coagulation of fluid preloading with 6% hydroxyethyl starch (HES) and lactated Ringer’s (LR) solution using thromboelastography (TEG) with kaolin-activated whole blood in healthy pregnant patients prior to spinal anesthesia for Cesarean delivery.

Methods: After obtaining Ethics committee approval, 30 parturients were prospectively randomized prior to spinal anesthesia for elective Cesarean delivery to receive fluid preloading with either 1500 mL LR or 500 mL 6% HES over 30 min. Thromboelastography was performed immediately prior to and after fluid preloading. Standard TEG parameters were analyzed in terms of r time (min), k time (min), angle (degrees) and maximum amplitude (mm).

Results: Group HES had statistically significant longer reaction times (r) and clot formation times (k) after fluid loading compared to baseline values (P < 0.05 respectively), although these post-fluid loading TEG parameters remained within a normal reference range. No significant differences in TEG values were seen after preloading within the LR group.

Conclusion: Fluid preloading with 500 mL 6% HES in healthy parturients produced mild coagulation effects, as measured with TEG, prior to spinal anesthesia for Cesarean delivery. No significant effects on coagulation with TEG were observed following preloading with 1500 mL LR.