{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T08:11:13Z","timestamp":1781079073637,"version":"3.54.1"},"reference-count":27,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,9,1]],"date-time":"2023-09-01T00:00:00Z","timestamp":1693526400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Fluid loading is an essential component of treatment for reducing the incidence of post-spinal anesthesia hypotension and is necessary to maintain intravascular volume, perfuse tissues, and control spinal anesthesia hypotension after sympathetic blockade. We performed a randomized sequential allocation dose-finding study to compare the effects of 10\u2009mL\/kg crystalloid and 6% hydroxyethyl starch (130\/0.4) co-load on the ED90 of prophylactic norepinephrine infusion for preventing post-spinal anesthesia hypotension during cesarean delivery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Eighty patients were randomly allocated to receive either a 10\u2009mL\/kg crystalloid (Crystalloid Group, <jats:italic>n<\/jats:italic>\u2009=\u200940) or 6% hydroxyethyl starch (130\/0.4) (Colloid Group, <jats:italic>n<\/jats:italic>\u2009=\u200940) co-load combined with prophylactic norepinephrine infusion during spinal anesthesia for cesarean delivery. The first patient received an initial prophylactic norepinephrine infusion rate of 0.025\u2009\u03bcg\/kg\/min. Subsequent patients received a 0.005\u2009\u03bcg\/kg\/min gradient dose of prophylactic norepinephrine. This dose was administered as a gradient based on its effectiveness for preventing post-spinal anesthesia hypotension (defined as SBP\u2009&amp;lt;\u200980% of baseline value) and determined by the up-and-down sequential allocation methodology. The primary study outcome was the ED90 of prophylactic norepinephrine infusion. Secondary outcomes included the incidence of post-spinal anesthesia hypotension, bradycardia, hypertension, Apgar scores, and umbilical artery blood gas values were also measured.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The ED90 values of prophylactic norepinephrine infusion for preventing post-spinal anesthesia hypotension during cesarean delivery were 0.063\u2009\u03bcg (95% CI: 0.050 to 0.064) and 0.062\u2009\u03bcg (95% CI: 0.045 to 0.064) using isotonic regression analysis, and 0.068\u2009\u03bcg (95% CI: 0.056 to 0.353) and 0.060\u2009\u03bcg (95% CI: 0.050 to 3.590) using probit regression analysis in the Crystalloid Group and Colloid Group, respectively. The secondary outcomes were comparable between the two groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The administration of a 10\u2009mL\/kg 6% hydroxyethyl starch (130\/0.4) does not provide additional benefits compared to crystalloid co-load in reducing the ED90 of prophylactic norepinephrine infusion for preventing post-spinal anesthesia hypotension during cesarean delivery.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2023.1214598","type":"journal-article","created":{"date-parts":[[2023,9,1]],"date-time":"2023-09-01T08:03:51Z","timestamp":1693555431000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["Comparison of crystalloid and colloid co-load combined with norepinephrine prophylaxis on post-spinal anesthesia hypotension during cesarean delivery: a randomized sequential allocation dose-finding study"],"prefix":"10.3389","volume":"10","author":[{"given":"Yi","family":"Chen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiangzhao","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rui","family":"Qin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Guo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinli","family":"Ni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,9,1]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"304","DOI":"10.1213\/ANE.0000000000003306","article-title":"Combined colloid preload and crystalloid coload versus crystalloid coload during spinal anesthesia for cesarean delivery a randomized 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Effects of vasoactive medications and maternal positioning during cesarean delivery on maternal hemodynamics and neonatal acid-base status","volume":"46","author":"Lee","year":"2019","journal-title":"Clin Perinatol"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"1916","DOI":"10.1213\/ANE.0b013e3181bbfdf6","article-title":"The effects of crystalloid and colloid preload on cardiac output in the parturient undergoing planned cesarean delivery under spinal anesthesia: a randomized trial","volume":"109","author":"Tamilselvan","year":"2009","journal-title":"Anesth Analg"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"647","DOI":"10.1177\/0310057X1003800337","article-title":"Effects of fluid preload (crystalloid or colloid) compared with crystalloid co-load plus ephedrine infusion on hypotension and neonatal outcome during spinal anaesthesia for caesarean delivery","volume":"38","author":"Gunusen","year":"2010","journal-title":"Anaesth Intensive Care"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"e69446","DOI":"10.5812\/aapm.69446","article-title":"The effects of pre-spinal anesthesia administration of crystalloid and colloid solutions on hypotension in elective cesarean section","volume":"8","author":"Gousheh","year":"2018","journal-title":"Anesth Pain Med"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"CD000567","DOI":"10.1002\/14651858.CD000567.pub7","article-title":"Colloids versus crystalloids for fluid resuscitation in critically ill people","volume":"8","author":"Lewis","year":"2018","journal-title":"Cochrane Database Syst Rev"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"1333","DOI":"10.3390\/jcm12041333","article-title":"Colloid preload versus crystalloid co-load in the setting of norepinephrine infusion during cesarean section: time and type of administered fluids do not matter","volume":"12","author":"Theodoraki","year":"2023","journal-title":"J Clin Med"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1016\/j.bpa.2017.01.001","article-title":"Spinal-induced hypotension: incidence, mechanisms, prophylaxis, and management: summarizing 20 years of research","volume":"31","author":"Lee","year":"2017","journal-title":"Best Pract Res Clin Anaesthesiol"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"611","DOI":"10.1213\/01.ane.0000437731.60260.ce","article-title":"A randomized controlled trial of variable rate phenylephrine infusion with rescue phenylephrine boluses versus rescue boluses alone on physician interventions during spinal anesthesia for elective cesarean delivery","volume":"118","author":"Siddik-Sayyid","year":"2014","journal-title":"Anesth Analg"},{"key":"ref27","first-page":"1019","article-title":"Colloids versus crystalloids in the prevention of hypotension induced by spinal anesthesia in elective cesarean section. 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