Fluid co-loading or preloading for the prevention of hypotension during spinal anesthesia for C-section: a narrative review

Background: Fluid management strategies are one of the potential strategies to prevent spinal induced hypotension in parturients scheduled for caesarean section. Objectives: This review will assess the current evidence on fluid strategies as a prophylactic measure for spinal induced hypotension. Methods: A narrative review was conducted where Pubmed, Embase and the Cochrane library were searched in November 2021 for RCTs, meta-analyses and systematic reviews, that compared different fluid regimen in ASA classification one or two women scheduled for elective caesarean section. Results: 77 studies were selected from initial screening, based on titles and abstracts. Out of the 77 initial studies, 37 were considered eligible for inclusion. Crystalloid preloading seemed ineffective in the prevention of spinal hypotension. Crystalloid co-loading, colloid pre- and co-loading all proved to reduce the incidence of spinal hypotension, as well as the incidence of nausea and vomiting and vasopressor use. There was no significant difference in neonatal outcome, regardless of the fluid regimen. Conclusion: Crystalloid co-loading, colloid co-loading and colloid preloading all have been shown to be effective in the prevention of spinal hypotension.