• Hai-Fang Ni, Hua-Yue Liu, Juan Zhang, Ke Peng, and Fu-Hai Ji.
• Department of Anesthesiology, First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou, Jiangsu 215006, China.
• Biomed Res Int. 2017 Jan 1; 2017: 3462529.

ObjectiveTo determine whether crystalloid infusion just after intrathecal injection (coload) would be better than infusion before anesthesia (preload) for hypotension prophylaxis in spinal anesthesia for cesarean delivery.MethodsWe searched PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and other databases for randomized controlled trials comparing coload of crystalloid with preload in parturients receiving spinal anesthesia for cesarean delivery. Primary outcome was intraoperative incidence of hypotension. Other outcomes were intraoperative need for vasopressors, hemodynamic variables, neonatal outcomes (umbilical artery pH and Apgar scores), and the incidence of maternal nausea and vomiting. We used RevMan 5.2 and STATA 12.0 for the data analyses.ResultsTen studies with 824 cases were included. The incidence of hypotension was significantly higher in the preload group compared with the coload group (57.8% versus 47.1%, odds ratio [OR] = 1.62, 95% confidence interval [CI] = 1.11-2.37, and P = 0.01). More patients needed intraoperative vasopressors (OR = 1.71, 95% CI = 1.07-2.04, and P = 0.02) when receiving crystalloid preload. In addition, the incidence of nausea and vomiting was higher in the preload group (OR = 3.40, 95% CI = 1.88-6.16, and P < 0.0001). There were no differences in neonatal outcomes between the groups.ConclusionsFor parturients receiving crystalloid loading in spinal anesthesia for cesarean delivery, coload strategy is superior to preload for the prevention of maternal hypotension.

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