Crystalloid Coload Reduced the Incidence of Hypotension in Spinal Anesthesia for Cesarean Delivery, When Compared to Crystalloid Preload: A Meta-Analysis

Table 1

Study characteristics.

Study	Group (number of patients)	Anesthesia	Procedure	Study protocol	Vasopressor	Outcome measures
Dyer et al.; 2004 [11]	Preload (25); (2) Coload (25)	Spinal anesthesia	Elective cesarean section	20 ml/kg modified Ringer’s lactate over 20 min before anesthesia; (2) 20 ml/kg modified Ringer’s lactate by rapid infusion at time of CSF identification	Ephedrine (5 mg)	Hypotension, MAP, need for vasopressors, umbilical arterial pH, Apgar score, nausea and vomiting
Farid et al.; 2016 [14]	Preload (37); (2) Coload (37)	Spinal anesthesia	Elective cesarean section	15 ml/kg Ringer’s lactate over 20 min before anesthesia; (2) 15 ml/kg Ringer’s lactate at time of anesthesia administration	Ephedrine; or phenylephrine (dose not provided)	Hypotension, need for vasopressors
Jain and Valecha; 2017 [15]	Preload (30); (2) Coload (30)	Spinal anesthesia	Elective cesarean section	15 ml/kg Ringer’s lactate over 20 min before anesthesia; (2) 15 ml/kg Ringer’s lactate over 20 min at time of CSF identification	Ephedrine (3 mg)	Hypotension, HR, SBP, Apgar score
Khan et al.; 2013 [16]	Preload (50); (2) Coload (50)	Spinal anesthesia	Elective cesarean section	20 ml/kg Ringer’s lactate over 20 min before anesthesia; (2) 20 ml/kg Ringer’s lactate by rapid infusion at time of CSF identification	Ephedrine (5 mg)	Hypotension, HR, SBP, MAP, need for vasopressors, Apgar score
Oh et al.; 2014 [17]	Preload (30); (2) Coload (30)	Spinal anesthesia	Elective cesarean section	15 ml/kg Ringer’s lactate by rapid infusion before anesthesia; (2) 15 ml/kg Ringer’s lactate after intrathecal injection	Ephedrine (5 mg)	Hypotension, need for vasopressors, umbilical arterial pH, Apgar score, nausea and vomiting
Rao and Vijaya; 2015 [12]	Preload (30); (2) Coload (30)	Spinal anesthesia	Elective cesarean section	15 ml/kg Ringer’s lactate over 20 min before anesthesia; (2) 15 ml/kg Ringer’s lactate by rapid infusion at time of CSF identification	Ephedrine (6 mg)	Hypotension, HR, SBP, MAP, need for vasopressors, Apgar score
Sarkar et al.; 2014 [18]	Preload (50); (2) Coload (50)	Spinal anesthesia	Emergency cesarean section	15 ml/kg Ringer’s lactate over 20 min before anesthesia; (2) 15 ml/kg Ringer’s lactate over 20 min after anesthesia	Ephedrine (3 mg)	Hypotension, need for vasopressors, Apgar score
Shah et al.; 2015 [19]	Preload (50); (2) Coload (50)	Spinal anesthesia	Elective cesarean section	10 ml/kg Ringer’s lactate over 15 min before anesthesia; (2) 10 ml/kg Ringer’s lactate at time of CSF identification	Ephedrine; or phenylephrine (dose not provided)	Hypotension, need for vasopressors
Sharma et al.; 2016 [20]	Preload (60); (2) Coload (60)	Spinal anesthesia	Elective cesarean section	20 ml/kg Ringer’s lactate over 20 min before anesthesia; (2) 20 ml/kg Ringer’s lactate by rapid infusion after intrathecal injection	Mephentermine; (3 mg)	Hypotension, need for vasopressors, SBP
Williams et al. 2012 [21]	Preload (50); (2) Coload (50)	Spinal anesthesia	Elective cesarean section	15 ml/kg Ringer’s lactate over 20 min before anesthesia; (2) 15 ml/kg Ringer’s lactate over 20 min at time of CSF identification	Ephedrine (3 mg)	Hypotension, HR, SBP, umbilical arterial pH, Apgar score, nausea and vomiting

CSF, cerebrospinal fluid; HR, heart rate; SBP, systolic blood pressure; MAP, mean arterial pressure.