Combined Colloid Preload And Crystalloid Coload Versus Crystalloid Coload During Spinal Anesthesia for Cesarean Delivery

NCT ID: NCT02961842

Last Updated: 2017-03-22

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

200 participants

Study Classification

INTERVENTIONAL

Study Start Date

2016-11-20

Study Completion Date

2017-03-09

Brief Summary

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The study will compare one technique of fluid administration (combined colloid preload and crystalloid colaod) with another one (crystalloid coload) during elective cesarean delivery performed under spinal anesthesia.

Detailed Description

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This randomized, controlled, double-blind study will be conducted on ASA physical status II parturients with full-term singleton pregnancy undergoing elective cesarean delivery under spinal anesthesia. Participants will receive either 500 mL colloid preload and 500 mL crystalloid coload (Combination group) or 1000 mL crystalloid coload (Coload group). Systolic blood pressure will be recorded every minute and ephedrine will be administered when hypotension occurs according to a predefined protocol. The total ephedrine dose, time to the first ephedrine dose, heart rate, inferior vena cava diameter, nausea/vomiting, and neonatal Apgar scores will be recorded.

Conditions

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Anesthesia, Spinal Cesarean Section

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

TRIPLE

Participants Investigators Outcome Assessors

Study Groups

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Combination

500 mL colloid preload and 500 mL crystalloid coload. Cesarean delivery performed under spinal anesthesia (intrathecal bupivacaine 12.5 mg and intrathecal fentanyl 15 µg). Ultrasound assessment of the Inferior vena cava diameter. Intravenous ephedrine will be administered.

Group Type EXPERIMENTAL

500 mL Colloid Preload

Intervention Type DRUG

6% hydroxyethyl starch 130/0.4 in 0.9% sodium chloride (voluven®) 500 mL will be rapidly infused before spinal anesthesia

Spinal Anesthesia

Intervention Type PROCEDURE

Performed at the L3-L4 or L4-L5 interspace using 27- or 25-gauge spinal needle

Intrathecal Bupivacaine

Intervention Type DRUG

Bupivacaine 12.5 mg (2.5 mL 0.5%) will be administered in the subarachnoid space

Intrathecal Fentanyl

Intervention Type DRUG

Fentanyl 15 µg will be administered in the subarachnoid space

500 mL Crystalloid Coload

Intervention Type DRUG

Ringer acetate 500 mL will be rapidly infused immediately after intrathecal injection

Cesarean Delivery

Intervention Type PROCEDURE

Lower segment cesarean section using the Pfannenstiel incision

Ultrasound Assessment of the Inferior Vena Cava

Intervention Type RADIATION

The inferior vena cava largest and smallest diameters will be measured proximal to the opening of the hepatic veins in the longitudinal axis with the M-mode using a 5-2 MHz curved array ultrasound probe placed longitudinally in the subxiphoid region

Intravenous Ephedrine

Intervention Type DRUG

Intravenous ephedrine 3, 5, and 10 mg will be administered when Systolic blood pressure decreases below 90%, 80%, and 70% of baseline, respectively.

Coload

1000 mL crystalloid coload. Cesarean delivery performed under spinal anesthesia (intrathecal bupivacaine 12.5 mg and intrathecal fentanyl 15 µg). Ultrasound assessment of the Inferior vena cava diameter. Intravenous ephedrine will be administered.

Group Type ACTIVE_COMPARATOR

Spinal Anesthesia

Intervention Type PROCEDURE

Performed at the L3-L4 or L4-L5 interspace using 27- or 25-gauge spinal needle

Intrathecal Bupivacaine

Intervention Type DRUG

Bupivacaine 12.5 mg (2.5 mL 0.5%) will be administered in the subarachnoid space

Intrathecal Fentanyl

Intervention Type DRUG

Fentanyl 15 µg will be administered in the subarachnoid space

1000 mL Crystalloid Coload

Intervention Type DRUG

Ringer acetate 1000 mL will be rapidly infused immediately after intrathecal injection

Cesarean Delivery

Intervention Type PROCEDURE

Lower segment cesarean section using the Pfannenstiel incision

Ultrasound Assessment of the Inferior Vena Cava

Intervention Type RADIATION

The inferior vena cava largest and smallest diameters will be measured proximal to the opening of the hepatic veins in the longitudinal axis with the M-mode using a 5-2 MHz curved array ultrasound probe placed longitudinally in the subxiphoid region

Intravenous Ephedrine

Intervention Type DRUG

Intravenous ephedrine 3, 5, and 10 mg will be administered when Systolic blood pressure decreases below 90%, 80%, and 70% of baseline, respectively.

Interventions

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500 mL Colloid Preload

6% hydroxyethyl starch 130/0.4 in 0.9% sodium chloride (voluven®) 500 mL will be rapidly infused before spinal anesthesia

Intervention Type DRUG

Spinal Anesthesia

Performed at the L3-L4 or L4-L5 interspace using 27- or 25-gauge spinal needle

Intervention Type PROCEDURE

Intrathecal Bupivacaine

Bupivacaine 12.5 mg (2.5 mL 0.5%) will be administered in the subarachnoid space

Intervention Type DRUG

Intrathecal Fentanyl

Fentanyl 15 µg will be administered in the subarachnoid space

Intervention Type DRUG

500 mL Crystalloid Coload

Ringer acetate 500 mL will be rapidly infused immediately after intrathecal injection

Intervention Type DRUG

1000 mL Crystalloid Coload

Ringer acetate 1000 mL will be rapidly infused immediately after intrathecal injection

Intervention Type DRUG

Cesarean Delivery

Lower segment cesarean section using the Pfannenstiel incision

Intervention Type PROCEDURE

Ultrasound Assessment of the Inferior Vena Cava

The inferior vena cava largest and smallest diameters will be measured proximal to the opening of the hepatic veins in the longitudinal axis with the M-mode using a 5-2 MHz curved array ultrasound probe placed longitudinally in the subxiphoid region

Intervention Type RADIATION

Intravenous Ephedrine

Intravenous ephedrine 3, 5, and 10 mg will be administered when Systolic blood pressure decreases below 90%, 80%, and 70% of baseline, respectively.

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* American Society of Anesthesiologists physical status II parturients
* Full term, singleton pregnancy
* Elective cesarean delivery under spinal anesthesia

Exclusion Criteria

* Age \<19 or \> 40 years
* Height \<150 cm
* Weight \<60 kg
* Body mass index ≥40 kg/m2
* Contraindications to spinal anesthesia (increased intracranial pressure, coagulopathy, or local skin infection)
* Chronic or pregnancy-induced hypertension
* Hemoglobin \<10 gm/dL.
* Diabetes mellitus, cardiovascular, cerebrovascular, or renal disease
* Polyhydramnios or known fetal abnormalities
Minimum Eligible Age

19 Years

Maximum Eligible Age

40 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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Mansoura University

OTHER

Sponsor Role lead

Responsible Party

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Mohamed Mohamed Tawfik

Lecturer, Department of anesthesia and surgical intensive care, principal investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Mohamed M Tawfik, MD

Role: PRINCIPAL_INVESTIGATOR

Mansoura University Hospital

Locations

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Department of Anesthesia, Mansoura University Hospitals

Al Mansurah, Dakahlia Governorate, Egypt

Site Status

Countries

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Egypt

References

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Tawfik MM, Tarbay AI, Elaidy AM, Awad KA, Ezz HM, Tolba MA. Combined Colloid Preload and Crystalloid Coload Versus Crystalloid Coload During Spinal Anesthesia for Cesarean Delivery: A Randomized Controlled Trial. Anesth Analg. 2019 Feb;128(2):304-312. doi: 10.1213/ANE.0000000000003306.

Reference Type DERIVED
PMID: 29461392 (View on PubMed)

Other Identifiers

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R/16.09.64

Identifier Type: -

Identifier Source: org_study_id

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