Before the block: fluid preloading and testing the catheter

  • Mark Scrutton
  • S. Michael Kinsella


Intravenous preloading was originally introduced to try to prevent or reduce hypotension caused by spinal anaesthesia for caesarean section.1 Following this, it became widely accepted that the same practice was appropriate for management of epidurals used for pain relief in labour. This occurred although such epidurals were given in smaller doses than those for caesarean section even before the introduction of low-dose epidural and combined spinal-epidural (CSE) techniques used on modern labour wards.


Epidural Analgesia Epidural Catheter Test Dose Fetal Heart Rate Confidential Enquiry 
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  1. 1.
    Wollman SB, Marx GF. Acute hydration for the prevention of hypotension of spinal anesthesia in parturients. Anesthesiology 1968; 29: 374–80PubMedCrossRefGoogle Scholar
  2. 2.
    Hahn RG, Drobin D, Stahle L. Volume kinetics of Ringer’s solution in female volunteers. Anaesthesia 1997; 78: 144–8CrossRefGoogle Scholar
  3. 3.
    Cochrane Injuries Group Albumin Reviewers. Human albumin administration in critically ill atients: systematic review of randomised controlled trials. BMJ 1998; 317: 235–40CrossRefGoogle Scholar
  4. Collins KM, Bevan DR, Beard DW. Fluid loading to reduce abnormalities of fetal heart rate and maternal hypotension during epidural analgesia in labour. BMJ 1978; ii: 1460–1Google Scholar
  5. 5.
    Spencer TAD, Koutsoukis M, Lee A. Fetal heart rate and neonatal condition related to epidural analgesia in women reaching the second stage of labour. Europ J Obstet Gynecol Reprod Biol 1991; 41: 173–8CrossRefGoogle Scholar
  6. 6.
    Steiger RM, Nageotte MP. Effect of uterine contractility and maternal hypotension on prolonged decelerations after bupivacaine epidural analgesia. Am J Obstet Gynecol 1990; 163: 808–12PubMedGoogle Scholar
  7. 7.
    Clarke VT, Smiley RM, Finster M. Uterine hyperactivity after intrathecal injection of fentanyl for analgesia during labor: a cause for fetal bradycardia? Anesthesiology 1994; 81: 1083PubMedCrossRefGoogle Scholar
  8. 8.
    Friedlander JD, Fox HE, Cain CF. Fetal bradycardia and uterine hyperactivity following subarachnoid administration of fentanyl during labor. Reg Anesth 1997; 22: 378–81PubMedCrossRefGoogle Scholar
  9. 9.
    Thimmons J, Laifer S, Ramanathan S. Subarachnoid fentanyl analgesia and uterine activity. Anesthesiology 1995; 83: A990Google Scholar
  10. 10.
    Thimmons J, Laifer S, Ramanathan S. Intravenous fluid bolus modifies the effects of intrathecal fentanyl on uterine activity. Abstract presented at Society of Obstetric Anesthesiology & Perinatology Annual Meeting, Tuscon 1996Google Scholar
  11. 11.
    Cheek TG, Samuels P Miller F, Tobin M, Gutsche BB. Normal saline iv fluid load decreases uterine activity in active labour. Br J Anaesth 1996; 77: 632–5PubMedCrossRefGoogle Scholar
  12. 12.
    Milaszkiewicz RM, Smith D, Carli F, Gordon H. Is fluid pre-loading before epidural analgesia in labour always necessary? J Obstet Gynaecol 1991; 11: 110–1CrossRefGoogle Scholar
  13. 13.
    Hammond RR, Webster AC. Haemodynamic effects of induction of epidural analgesia in labour. Can J Anaesth 1988; 35: 41–6PubMedCrossRefGoogle Scholar
  14. 14.
    Patton DE, Lee W, Miller J, Jones M. Maternal, uteroplacental and fetoplacental hemodynamic and Doppler velocimetric changes during epidural analgesia in normal labor. Obstet Gynecol 1991; 77: 17–19PubMedGoogle Scholar
  15. 15.
    Timko Shannon M, Crivelli K, Ramanathan S. Is intravenous fluid bolus necessary before subarachnoid fentanyl administration for labor analgesia? Anesthesiology 1995; 83: A941Google Scholar
  16. 16.
    Slaymaker A, Bamber J, Hawthorne L, Dresner M. Is a fluid preload necessary with low-dose epidural analgesia in labour? (Abstract) International Journal of Obstetric Anesthesia 1998; 7: 197–198.Google Scholar
  17. 17.
    Zamora JE, Rosaeg OP, Lindsay MP, Crossan ML. Haemodynamic consequences and uterine contractions following 0.5 or 1.0 litre crystalloid infusions before obstetric epidural analgesia. Can J Anaesth 1996; 43: 347–52PubMedCrossRefGoogle Scholar
  18. 18.
    Jackson R, Reid JA, Thorburn J. Volume preloading is not essential to prevent spinal-induced hypotension at caesarean section. B J Anaesth 1995; 75: 262–5CrossRefGoogle Scholar
  19. 19.
    Husaini SW, Russell IF. Volume preload: lack of effect in the prevention of spinal-induced hypotension at caesarean section. International Journal of Obstetric Anesthesia 1998; 7: 76–81PubMedCrossRefGoogle Scholar
  20. Why mothers die; report on confidential enquiries into maternal deaths in the United Kingdom 1994–1996. HMSO, 1998Google Scholar
  21. 21.
    Ramsay IN, Torbet TE. Incidence of abnormal voiding parameters in the immediate postpartum period. Neurology and Urodynamics 1993; 12: 179–83CrossRefGoogle Scholar
  22. 22.
    Hinman F. Postoperative overdistension of the bladder. Surg Gynecol Obstet 1976; 142: 901–2PubMedGoogle Scholar
  23. 23.
    Tarno-Mordi WO, Shaw JCL, Lin D, Gardner DA, Flynn FV. Iatrogenic hyponatraemia of the newborn due to maternal fluid overload: a prospective study. BMJ 1981; 283: 639–642CrossRefGoogle Scholar
  24. 24.
    Feeney JG. Water intoxication and oxytocin. BMJ 1982; 284: 243CrossRefGoogle Scholar
  25. 25.
    Ames A, Cobbold S, Maddock J. Lactic acidosis complicating treatment of ketosis in labour. BMJ 1975; 4: 611–613PubMedCrossRefGoogle Scholar
  26. 26.
    Kenepp NB, Shelley WC, Gabbe SG, Kumar S, Stanley CA, Gutsche RB. Fetal and neonatal hazards of maternal hydration with 5% dextrose before caesarean section. Lancet 1982; 1: 1150–1152PubMedCrossRefGoogle Scholar
  27. 27.
    Lawrence GF, Brown VA, Parsons RJ, Cooke ID. Feto-maternal consequences of high-dose glucose infusion during labour. Br J Obstet Gynaecol 1982; 89: 27–32PubMedCrossRefGoogle Scholar
  28. Report on confidential enquiries into maternal deaths in the United Kingdom 1991–1993. HMSO, 1996Google Scholar
  29. 29.
    Department of Health. Changing Childbirth. London: HMSO; 1993Google Scholar
  30. 30.
    Albright GA. Cardiac arrest following regional anesthesia with etidocaine or bupivacaine. Anesthesiology 1979; 51: 285–7PubMedCrossRefGoogle Scholar
  31. 31.
    Kenepp NB, Gutsche BB. Inadvertant intravascular injections during lumbar epidural analgesia. Anesthesiology 1981; 54: 172–3PubMedCrossRefGoogle Scholar
  32. 32.
    Norris MC, Fogel ST, Dalman H, Borrenpohl S, Hoppe W, Riley A. Labor epidural analgesia without an intravascular “test dose”. Anesthesiology 1998; 88: 1495–501PubMedCrossRefGoogle Scholar
  33. 33.
    Beck H, Brassow F, Doehn M, Bause H. Epidural catheters of the multi-orifice type: dangers and complications. Acta Anaesthesiol Scand 1986; 30: 549–55PubMedCrossRefGoogle Scholar
  34. 34.
    Moore DC, Batra MS. The components of an effective test dose prior to epidural block. Anesthesiology 1981; 55: 693–6PubMedCrossRefGoogle Scholar
  35. 35.
    Leighton BL, Norris MC, DeSimone CA, Epstein R. The epinephrine test dose revisited, again. Anesthesiology 1988; 68: 807PubMedCrossRefGoogle Scholar
  36. 36.
    Hood DID, Dewan DM, James FM. Maternal and fetal effects of epinephrine in gravid ewes. Anesthesiology 1986; 64: 610–13PubMedCrossRefGoogle Scholar
  37. 37.
    Chestnut DH, Weiner CP, Herrig JE, Wang J. Effect of intravenous epinephrine upon uterine blood flow velocity in the pregnant guinea pig. Anesthesiology 1986; 65: 633–36PubMedCrossRefGoogle Scholar
  38. 38.
    Cartwright PD, McCarroll SM, Antzaka C. Maternal heart rate changes with a plain epidural test dose. Anesthesiology 1986; 65: 226–8PubMedCrossRefGoogle Scholar
  39. 39.
    Leighton BL, Norris MC, Sosis M, Epstein R, Chayen B, Larijani GE. Limitations of epinephrine as a marker of intravascular injection in laboring women. Anesthesiology 1987; 66: 688–91PubMedCrossRefGoogle Scholar
  40. 40.
    Norris MC, Ferrenbach D, Dalman H, Fogel ST, Borrenpohl S, Hoppe W, Riley A. Does epinephrine improve the diagnostic accuracy of aspiration during labor epidural analgesia? Anesth Analg 1999; 88: 1073–6PubMedGoogle Scholar
  41. 41.
    Leighton BL, DeSimone C, Norris MC, Chayen B. Isoproterenol is an effective marker of intravenous injection in laboring women. Anesthesiology 1989; 71: 206–9PubMedCrossRefGoogle Scholar
  42. 42.
    Cherala SR, Greene RG. Ephedrine as a marker of intravascular injection in laboring parturients. Reg Anesth 1990; 15: 15–18PubMedGoogle Scholar
  43. 43.
    Rottman RL, Miller M, Yoshii WY, Kotelko DM, Wright WC, Stone JJ, Rasmus KT. Fentanyl as an epidural intravascular test dose in obstetrics. Anesth Analg 1990; 70: S336CrossRefGoogle Scholar
  44. 44.
    Leighton BL, Gross JB. Air: an effective indicator of intravenously located epidural catheters. Anesthesiology 1989; 71: 848–51PubMedCrossRefGoogle Scholar
  45. 45.
    el-Behesy BA, James D, Koh KF, Hirsch N. Distinguishing cerebrospinal fluid from saline used to identify the epidural space. Br J Anaesth 1996; 77: 784–5PubMedCrossRefGoogle Scholar
  46. 46.
    Richardson MG, Lee AC, Wissler RN. High spinal anesthesia after epidural test dose in five obstetric patients. Reg Anesth 1996; 21: 119–23PubMedGoogle Scholar
  47. 47.
    Richardson MG, Wissler RN. Unexpected high spinal block in obstetrics. Br J Anaesth 1996: 77: 806PubMedCrossRefGoogle Scholar
  48. 48.
    Palkar NV, Boudreaux RC, Mankad AV. Accidental total spinal block: a complication of an epidural test dose. Can J Anaesth 1992; 39: 1058–60PubMedCrossRefGoogle Scholar
  49. 49.
    Evans TI. Total spinal anaesthesia. Anaesth Intensive Care 1974; 2: 158–63PubMedGoogle Scholar
  50. 50.
    Fine PG, Wong KC. Cranial nerve block after test dose through an epidural catheter in a preeclamptic. Can Anaesth Soc J 1984; 31: 565–7PubMedCrossRefGoogle Scholar
  51. 51.
    Stonham J, Moss P. The optimal test dose for dose for epidural anesthesia. Anesthesiology 1983; 58: 389–90PubMedCrossRefGoogle Scholar
  52. 52.
    Russell IF. Inadvertent total spinal for caesarean section. Anaesthesia 1985; 40: 199–200PubMedCrossRefGoogle Scholar
  53. 53.
    Vucevic M, Russell IF. Spinal anaesthesia for caesarean section: 0.125% plain bupivacaine 12 ml compared with 0.5% plain bupivacaine 3 ml. Br J Anaesth 1992; 68: 590–5PubMedCrossRefGoogle Scholar
  54. 54.
    Van Zundert AA, De Wolf AM, Vaes L, Soetens M. High volume spinal anesthesia with bupivacaine 0.125% for cesarean section. Anesthesiology 1988; 69: 998–1003PubMedCrossRefGoogle Scholar
  55. 55.
    Cox M, Lawton G, Gowrie-Mohan S, Morgan B. Let us re-examine the safety of midwife epidural top ups. Anaesthesia 1995; 50: 750–1PubMedCrossRefGoogle Scholar
  56. 56.
    Reynolds F, Speedy HM. The subdural space: the third place to go astray. Anaesthesia 1990; 45: 120–3PubMedCrossRefGoogle Scholar
  57. 57.
    Russell R. Practical Procedures. In: Reynolds F ed. Pain Relief in Labour.London: BMJ Publishing Group, 1997: 193–4Google Scholar

Copyright information

© Springer-Verlag London 2000

Authors and Affiliations

  • Mark Scrutton
  • S. Michael Kinsella

There are no affiliations available

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