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

  • Alexander Butwick
  • Brendan Carvalho
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 
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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.


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Copyright information

© Canadian Anesthesiologists 2007

Authors and Affiliations

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

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