Canadian Journal of Anesthesia

, Volume 54, Issue 3, pp 190–195 | Cite as

The effect of colloid and crystalloid preloading on thromboelastography prior to Cesarean delivery

Reports of Original Investigations



Fluid preloading with colloids reduces hypotension after spinal anesthesia for Cesarean delivery more effectively than crystalloids. However, the effects of fluid preloading regimens on coagulation in pregnant patients remain unresolved. The aim of this study was to compare the effects on coagulation of fluid preloading with 6% hydroxyethyl starch (HES) and lactated Ringer’s (LR) solution using thromboelastography (TEG) with kaolin-activated whole blood in healthy pregnant patients prior to spinal anesthesia for Cesarean delivery.


After obtaining Ethics committee approval, 30 parturients were prospectively randomized prior to spinal anesthesia for elective Cesarean delivery to receive fluid preloading with either 1500 mL LR or 500 mL 6% HES over 30 min. Thromboelastography was performed immediately prior to and after fluid preloading. Standard TEG parameters were analyzed in terms of r time (min), k time (min), α angle (degrees) and maximum amplitude (mm).


Group HES had statistically significant longer reaction times (r) and clot formation times (k) after fluid loading compared to baseline values (P < 0.05 respectively), although these post-fluid loading TEG parameters remained within a normal reference range. No significant differences in TEG values were seen after preloading within the LR group.


Fluid preloading with 500 mL 6% HES in healthy parturients produced mild coagulation effects, as measured with TEG, prior to spinal anesthesia for Cesarean delivery. No significant effects on coagulation with TEG were observed following preloading with 1500 mL LR.


Cesarean Delivery Spinal Anesthesia Lactate Ringer Hydroxyethyl Starch Normal Reference Range 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

L’effet d’une précharge avec un colloïde ou un cristalloïde sur le thromboélastogramme avant l’accouchement par césarienne



La précharge liquidienne avec un colloïde plutôt qu’avec un cristalloïde réduit plus efficacement l’hypotension associée à la rachianesthésie lors de l’accouchement par césarienne. Toutefois, les effets de l’administration d’une précharge liquidienne sur la coagulation chez les patientes enceintes demeurent inconnus. L’objectif de cette étude était de comparer les effets sur la coagulation d’une précharge liquidienne avec de l’amidon hydroxyéthylé (AHE) 6 % et une solution de lactate Ringer (LR) en utilisant un thromboélastogramme (TEG) avec du sang complet activé au kaolin chez les patientes enceintes saines avant la rachianesthésie pour l’accouchement par césarienne.


Avec l’approbation du comité d’éthique, 30 parturientes ont été prospectivement randomisées, avant la rachianesthésie pour l’accouchement par césarienne, à recevoir une précharge liquidienne de 1 500 mL LR ou 500 mL AHE 6 % en 30 min. Un thromboélastogramme a été effectué immédiatement avant et après l’administration de la précharge liquidienne. Les paramètres standard du TEG ont été utilisés en fonction du temps r (min), du temps k (min), de l’angle α (degrés) et de l’amplitude maximum (mm).


Le groupe AHE a présenté des temps de réaction (r) et de formation de caillots (k) statistiquement plus longs après charge liquidienne en comparaison des valeurs de base (P < 0,05 respectivement), bien que ces paramètres de TEG après charge liquidienne soient restés dans une marge de référence normale. Aucune différence significative dans les valeurs du TEG n’a été observée après précharge dans le groupe RL.


La précharge liquidienne avec 500 mL de AHE 6 % chez les parturientes en bonne santé a eu des effets légers sur la coagulation selon les mesures prises avec le TEG avant la rachianesthésie pour accouchement par césarienne. Aucun effet significatif sur la coagulation avec TEG n’a été observé suite à une précharge de 1 500 mL LR.


  1. 1.
    Morgan PJ, Halpern SH, Tarshis J. The effects of an increase of central blood volume before spinal anesthesia for cesarean delivery: a qualitative systematic review. Anesth Analg 2001; 92: 997–1005.PubMedCrossRefGoogle Scholar
  2. 2.
    Riley ET, Cohen SE, Rubenstein AJ, Flanagan B. Prevention of hypotension after spinal anesthesia for cesarean section: six percent hetastarch versus lactated Ringer’s solution. Anesth Analg 1995; 81: 838–42.PubMedCrossRefGoogle Scholar
  3. 3.
    Ueyama H, He YL, Tanigami H, Mashimo T, Yoshiya I. Effects of crystalloid and colloid preload on blood volume in the parturient undergoing spinal anesthesia for elective cesarean section. Anesthesiology 1999; 91: 1571–6.PubMedCrossRefGoogle Scholar
  4. 4.
    Sharma SK, Philip J. The effect of anesthetic techniques on blood coagulability in parturients as measured by thromboelastography. Anesth Analg 1997; 85: 82–6.PubMedCrossRefGoogle Scholar
  5. 5.
    Jamnicki M, Bombeli T, Seifert B, et al. Low- and medium-molecular-weight hydroxyethyl starches: comparison of their effect on blood coagulation. Anesthesiology 2000; 93: 1231–7.PubMedCrossRefGoogle Scholar
  6. 6.
    Ng KF, Lam CC, Chan LC. In vivo effect of haemodilution with saline on coagulation: a randomized controlled trial. Br J Anaesth 2002; 88: 475–80.PubMedCrossRefGoogle Scholar
  7. 7.
    Egli GA, Zollinger A, Seifert B, Popovic D, Pasch T, Spahn DR. Effect of progressive haemodilution with hydroxyethyl starch, gelatin and albumin on blood coagulation. Br J Anaesth 1997; 78: 684–9.PubMedGoogle Scholar
  8. 8.
    Ruttmann TG, James MF, Aronson I. In vivo investigation into the effects of haemodilution with hydroxyethyl starch (200/0.5) and normal saline on coagulation. Br J Anaesth 1998; 80: 612–6.PubMedGoogle Scholar
  9. 9.
    Petroianu GA, Liu J, Maleck WH, Mattinger C, Bergler WF. The effect of in vitro hemodilution with gelatin, dextran, hydroxyethyl starch, or Ringer’s solution on thrombelastograph. Anesth Analg 2000; 90: 795–800.PubMedCrossRefGoogle Scholar
  10. 10.
    Ruttmann TG, James MF, Viljoen JF. Haemodilution induces a hypercoagulable state. Br J Anaesth 1996; 76: 412–4.PubMedGoogle Scholar
  11. 11.
    Sharma SK, Philip J, Wiley J. Thromboelastographic changes in healthy parturients and postpartum women. Anesth Analg 1997; 85: 94–8.PubMedCrossRefGoogle Scholar
  12. 12.
    Mallett SV, Cox DJ. Thrombelastography. Br J Anaesth 1992; 69: 307–13.PubMedCrossRefGoogle Scholar
  13. 13.
    Ruttmann TG, James MF, Wells KF. Effect of 20% in vitro haemodilution with warmed buffered salt solution and cerebrospinal fluid on coagulation. Br J Anaesth 1999; 82: 110–1.PubMedGoogle Scholar
  14. 14.
    Gorton H, Lyons G, Manraj P. Preparation for regional anaesthesia induces changes in thrombelastography. Br J Anaesth 2000; 84: 403–4.PubMedGoogle Scholar
  15. 15.
    Holmes VA, Wallace JM. Haemostasis in normal pregnancy: a balancing act? Biochem Soc Trans 2005; 33(Pt 2): 428–32.PubMedCrossRefGoogle Scholar
  16. 16.
    Boldt J, Haisch G, Suttner S, Kumle B, Schellhaass A. Effects of a new modified, balanced hydroxyethyl starch preparation (Hextend) on measures of coagulation. Br J Anaesth 2002; 89: 722–8.PubMedCrossRefGoogle Scholar
  17. 17.
    Dailey SE, Dysart CB, Langan DR, et al. An in vitro study comparing the effects of Hextend, Hespan, normal saline, and lactated ringer’s solution on thrombelastography and the activated partial thromboplastin time. J Cardiothorac Vasc Anesth 2005; 19: 358–61.PubMedCrossRefGoogle Scholar
  18. 18.
    Kozek-Langenecker SA. Effects of hydroxyethyl starch solutions on hemostasis. Anesthesiology 2005; 103: 654–60.PubMedCrossRefGoogle Scholar
  19. 19.
    Strauss RG, Pennell BJ, Stump DC. A randomized, blinded trial comparing the hemostatic effects of pentastarch versus hetastarch. Transfusion 2002; 42: 27–36.PubMedCrossRefGoogle Scholar
  20. 20.
    von Roten I, Madjdpour C, Frascarolo P, et al. Molar substitution and C2/C6 ratio of hydroxyethyl starch: influence on blood coagulation. Br J Anaesth 2006; 96: 455–63.CrossRefGoogle Scholar
  21. 21.
    Ruttmann TG, James MF, Finlayson J. Effects on coagulation of intravenous crystalloid or colloid in patients undergoing peripheral vascular surgery. Br J Anaesth 2002; 89: 226–30.PubMedCrossRefGoogle Scholar
  22. 22.
    Rai R, Tuddenham E, Backos M, et al. Thromboelastography, whole-blood haemostasis and recurrent miscarriage. Hum Reprod 2003; 18: 2540–3.PubMedCrossRefGoogle Scholar
  23. 23.
    Sharma SK, Philip J, Whitten CW, Padakandla UB, Landers DF. Assessment of changes in coagulation in parturients with preeclampsia using thromboelastography. Anesthesiology 1999; 90: 385–90.PubMedCrossRefGoogle Scholar
  24. 24.
    Orlikowski CE, Rocke DA, Murray WB, et al. Thrombelastography changes in pre-eclampsia and eclampsia. Br J Anaesth 1996; 77: 157–61.PubMedGoogle Scholar

Copyright information

© Canadian Anesthesiologists 2007

Authors and Affiliations

  1. 1.Department of Anesthesia, H3580Stanford University School of MedicineStanfordUSA

Personalised recommendations