6% Hydroxyethyl starch (130/0.4) vs Ringer’s lactate preloading before spinal anaesthesia for Caesarean delivery: the randomized, double-blind, multicentre CAESAR trial.

This French multicentre study compared the effect of HES / Ringer Lactate (RL) combination (500 mL each) versus RL alone (1000 mL) on the hypotension induced by spinal anaesthesia with phenylephrine prophylaxis in healthy pregnant women undergoing elective Caesarean delivery (excluding patients with prior hypertensive disorders). While the HES / RL combination was associated with significantly less severe hypotension (below 80% of the values of the baseline systolic blood pressure), the use of phenylephrine was similar in both groups, suggesting the contrary. This is unfortunately not explained in the manuscript and is probably represents an important limitation in this study. Further studies with a modified protocol (use of phenylephrine only if the fall in blood pressure exceeds at least 80% of the baseline value or is symptomatic) should answer the question about whether using HES in this specific indication is appropriate or not.

– Michael Piagnerelli

Discuss this article on the Nataonline forum