AANA journal
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Randomized Controlled Trial
Effect of timing of fluid bolus on reduction of spinal-induced hypotension in patients undergoing elective cesarean delivery.
Spinal-induced hypotension remains the most common complication associated with spinal anesthesia for cesarean delivery. Recent evidence indicates that a 20-mL/kg bolus via pressurized infusion system administered at the time of subarachnoid block (SAB) (coload) may provide better prophylaxis than the traditional administration of a 20-mL/kg crystalloid infusion (preload) approximately 20 minutes before SAB; however, this method raises some concerns. We hypothesized that administering half of the fluid bolus (10 mL/kg) before and half immediately following injection of the SAB would provide benefit. ⋯ No differences in neonatal outcomes were noted between groups. Maternal vital signs were not significantly different between groups; hypotension was treated as it occurred. We recommend replacing standardized prophylactic crystalloid fluid administration with the preload/coload method described herein.
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Randomized Controlled Trial
Preoperative fluid bolus and reduction of postoperative nausea and vomiting in patients undergoing laparoscopic gynecologic surgery.
We conducted a randomized clinical trial of patients undergoing laparoscopic gynecologic surgery to determine the effect of a calculated preoperative fluid bolus on postoperative nausea and vomiting (PONV). For the study, 46 women were randomly assigned to an experimental group, group 1, or a control group, group 2. Group 1 received up to 1,000 mL of replacement fluid preoperatively, using the 4-2-1 formula. ⋯ Demographic and other factors reported to cause PONV, such as the length of surgery and major manipulation of the bowels, were similar in both groups. There was no significant difference between groups in reception of postoperative opioid, a known cause of PONV. Drops in blood pressure were thought to affect PONV, but group 1 patients had larger decreases in blood pressure than did group 2 patients.