{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T20:25:31Z","timestamp":1788553531362,"version":"build-2803163510"},"reference-count":28,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,7,9]],"date-time":"2025-07-09T00:00:00Z","timestamp":1752019200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100018534","name":"Medical Innovation Project of Fujian Province","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100018534","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Hypotension is a common complication of spinal anesthesia during cesarean section, and no single intervention has been shown to eliminate maternal hypotension. Fluid loading strategies combined with vasopressor drug regimens can achieve this goal by maximizing cardiac output (CO) and minimizing the fall in systemic vascular resistance (SVR). However, the optimal fluid volume, type, and timing of administration have not been fully elucidated. Therefore, this study aimed to use Vigileo techniques in order to compare the effects of different fluid loading strategies on CO fluctuation under a norepinephrine infusion.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We recruited 102 healthy term parturients scheduled for elective cesarean section under spinal anesthesia for this randomized double-blind study and divided them into two groups: the colloid preload followed by crystalloid coload group (500 ml each; Group 1, <jats:italic>n<\/jats:italic> = 51), and the colloid and crystalloid coload group (500 ml each; Group 2, <jats:italic>n<\/jats:italic> = 51). The infusion of norepinephrine was started after intrathecal injection. Vigileo was used to monitor invasive hemodynamic indices. Our primary outcome was standardized maternal cardiac output (CO) readings taken from spinal anesthesia until delivery. The secondary outcome measures were stroke volume (SV), systolic blood pressure (SBP), heart rate (HR), number of episodes of hypotension, hypertension, bradycardia, nausea\/vomiting and total norepinephrine dose. Neonatal outcome was assessed by recording Apgar scores 1 and 5 min after delivery and by measuring umbilical arterial (UA) blood gases. Continuous hemodynamic monitoring was performed during the first 15 min after spinal anesthesia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Baseline CO, SV, and SBP were similar for both groups. Before spinal anesthesia, CO (6.84 \u00b1 1.18 vs. 5.51 \u00b1 0.96 L\/min, <jats:italic>P<\/jats:italic> &amp;lt; 0.001) was significantly higher in group 1 than group 2, but this increase was not sustained after spinal anesthesia (<jats:italic>P<\/jats:italic> &amp;gt; 0.05). SV (75.98 \u00b1 13.01 vs. 66.37 \u00b1 12.42 mL, <jats:italic>P<\/jats:italic> &amp;lt; 0.001) and SBP (124.84 \u00b1 11.61 vs. 116.57 \u00b1 7.57 mmHg, <jats:italic>P<\/jats:italic> &amp;lt; 0.001); followed a similar trend in the study. Only the largest percentage change in maternal HR (4.89 \u00b1 11.89 vs. 10.38 \u00b1 14.07, <jats:italic>P<\/jats:italic> = 0.036) was significantly different between the two groups. There were no significant differences between the two groups in terms of the maximum CO, SV, SBP, or HR after spinal anesthesia (<jats:italic>P<\/jats:italic> &amp;gt; 0.05). The maternal side effects and neonatal outcomes, were similar in two groups (<jats:italic>P<\/jats:italic> &amp;gt; 0.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In combination with prophylactic norepinephrine infusion, 500-mL colloid preloading and 500-mL crystalloid coloading can significantly increase CO before spinal anesthesia for cesarean sections and provide improved hemodynamic stability after spinal anesthesia, with no difference in maternal or neonatal outcomes as compared to colloid and crystalloid coloading.<\/jats:p><\/jats:sec><jats:sec><jats:title>Clinical trial registration<\/jats:title><jats:p><jats:uri>https:\/\/www.chictr.org.cn<\/jats:uri>, identifier ChiCTR2300073333.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2025.1421947","type":"journal-article","created":{"date-parts":[[2025,7,10]],"date-time":"2025-07-10T05:45:00Z","timestamp":1752126300000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Effect of combined colloid preloading and crystalloid coloading versus combined colloid and crystalloid coloading on maternal cardiac output during spinal anesthesia for cesarean section under combined prophylactic noradrenaline infusion"],"prefix":"10.3389","volume":"12","author":[{"given":"Xiang","family":"Gao","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sumei","family":"Hu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chuantao","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"You","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shihong","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianying","family":"Yan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,7,9]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1067","DOI":"10.1097\/EJA.0000000000001474","article-title":"Treatment of spinal anaesthesia-induced hypotension with cafedrine\/theodrenaline versus ephedrine during caesarean section: Results from HYPOTENS, a national, multicentre, prospective, noninterventional study.","volume":"38","author":"Kranke","year":"2021","journal-title":"Eur J Anaesthesiol."},{"key":"B2","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1111\/anae.14080","article-title":"International consensus statement on the management of hypotension with vasopressors during caesarean section under spinal anaesthesia.","volume":"73","author":"Kinsella","year":"2018","journal-title":"Anaesthesia."},{"key":"B3","doi-asserted-by":"publisher","first-page":"743","DOI":"10.1111\/anae.15363","article-title":"Noradrenaline - at best it is not worse. A comparison with phenylephrine in women undergoing spinal anaesthesia for caesarean section.","volume":"76","author":"Heesen","year":"2021","journal-title":"Anaesthesia."},{"key":"B4","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1016\/j.ijsu.2020.10.006","article-title":"Prevention of hypotension during elective cesarean section with a fixed-rate norepinephrine infusion versus a fixed-rate phenylephrine infusion. A double-blinded randomized controlled trial.","volume":"84","author":"Theodoraki","year":"2020","journal-title":"Int J Surg."},{"key":"B5","doi-asserted-by":"publisher","first-page":"1043","DOI":"10.1097\/CM9.0000000000001477","article-title":"Effects of colloid preload on the incidence of hypotension in spinal anesthesia for cesarean section: A systematic review and meta-analysis.","volume":"134","author":"Gong","year":"2021","journal-title":"Chin Med J (Engl)."},{"key":"B6","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1007\/s10877-006-9066-4","article-title":"Comparison of effects of rapid colloid loading before and after spinal anesthesia on maternal hemodynamics and neonatal outcomes in cesarean section.","volume":"21","author":"Nishikawa","year":"2007","journal-title":"J Clin Monit Comput."},{"key":"B7","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1016\/j.ijoa.2006.07.004","article-title":"A randomized trial of crystalloid versus colloid solution for prevention of hypotension during spinal or low-dose combined spinal-epidural anesthesia for elective cesarean delivery.","volume":"16","author":"Ko","year":"2007","journal-title":"Int J Obstet Anesth."},{"key":"B8","doi-asserted-by":"publisher","first-page":"150","DOI":"10.1016\/j.ijoa.2008.12.006","article-title":"Hetastarch co-loading is as effective as pre-loading for the prevention of hypotension following spinal anesthesia for cesarean delivery.","volume":"18","author":"Carvalho","year":"2009","journal-title":"Int J Obstet Anesth."},{"key":"B9","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1111\/anae.14841","article-title":"Prevention of hypotension after spinal anaesthesia for caesarean section: A systematic review and network meta-analysis of randomised controlled trials.","volume":"75","author":"Fitzgerald","year":"2020","journal-title":"Anaesthesia."},{"key":"B10","doi-asserted-by":"publisher","first-page":"793","DOI":"10.1038\/jp.2017.53","article-title":"Cardiac hemodynamics before, during and after elective cesarean section under spinal anesthesia in low-risk women.","volume":"37","author":"Ram","year":"2017","journal-title":"J Perinatol."},{"key":"B11","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1093\/bja\/68.1.54","article-title":"Maternal and fetal haemodynamic effects of spinal and extradural anaesthesia for elective caesarean section.","volume":"68","author":"Robson","year":"1992","journal-title":"Br J Anaesth."},{"key":"B12","doi-asserted-by":"publisher","first-page":"726","DOI":"10.7326\/0003-4819-152-11-201006010-00232","article-title":"CONSORT 2010 statement: Updated guidelines for reporting parallel group randomized trials.","volume":"152","author":"Schulz","year":"2010","journal-title":"Ann Intern Med."},{"key":"B13","doi-asserted-by":"publisher","first-page":"192","DOI":"10.1097\/ALN.0000000000002182","article-title":"A review of the impact of obstetric anesthesia on maternal and neonatal outcomes.","volume":"129","author":"Lim","year":"2018","journal-title":"Anesthesiology."},{"key":"B14","doi-asserted-by":"publisher","first-page":"4754","DOI":"10.3390\/jcm12144754","article-title":"Reply to Ak\u00e7a, B.; Bilotta, F. time and type of administered fluids during cesarean section might not matter for hemodynamic outcomes, but there are significant patient safety concerns regarding colloid use in parturients. Comment on;Theodoraki et al. 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":"B15","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":"B16","doi-asserted-by":"publisher","first-page":"803","DOI":"10.1213\/ANE.0b013e31822c0f08","article-title":"Maternal cardiac output changes after crystalloid or colloid coload following spinal anesthesia for elective cesarean delivery: A randomized controlled trial.","volume":"113","author":"McDonald","year":"2011","journal-title":"Anesth Analg."},{"key":"B17","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s40199-023-00479-7","article-title":"Prophylactic norepinephrine combined with 6% hydroxyethyl starch (130\/0.4) co-load infusion for preventing postspinal anesthesia hypotension during cesarean section: A randomized, controlled, dose-finding trial.","volume":"32","author":"Guo","year":"2024","journal-title":"Daru."},{"key":"B18","doi-asserted-by":"publisher","first-page":"299","DOI":"10.1097\/00000539-199608000-00017","article-title":"The effects of varying volumes of crystalloid administration before cesarean delivery on maternal hemodynamics and colloid osmotic pressure.","volume":"83","author":"Park","year":"1996","journal-title":"Anesth Analg."},{"key":"B19","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":"B20","doi-asserted-by":"publisher","first-page":"1592","DOI":"10.1213\/ane.0b013e31819e016d","article-title":"Colloid preload versus coload for spinal anesthesia for cesarean delivery: The effects on maternal cardiac output.","volume":"108","author":"Teoh","year":"2009","journal-title":"Anesth Analg."},{"key":"B21","doi-asserted-by":"publisher","first-page":"1120","DOI":"10.1213\/ANE.0000000000001174","article-title":"Hemodynamics of phenylephrine infusion versus lower extremity compression during spinal anesthesia for cesarean delivery: A randomized, double-blind, placebo-controlled study.","volume":"122","author":"Kuhn","year":"2016","journal-title":"Anesth Analg."},{"key":"B22","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1016\/j.ijoa.2016.08.005","article-title":"An open-label randomized controlled clinical trial for comparison of continuous phenylephrine versus norepinephrine infusion in prevention of spinal hypotension during cesarean delivery.","volume":"29","author":"Vallejo","year":"2017","journal-title":"Int J Obstet Anesth."},{"key":"B23","doi-asserted-by":"publisher","first-page":"850","DOI":"10.1111\/anae.14675","article-title":"A randomised controlled trial of phenylephrine and noradrenaline boluses for treatment of postspinal hypotension during elective caesarean section.","volume":"74","author":"Mohta","year":"2019","journal-title":"Anaesthesia."},{"key":"B24","doi-asserted-by":"publisher","first-page":"540","DOI":"10.1213\/ANE.0000000000006244","article-title":"Manually controlled, continuous infusion of phenylephrine or norepinephrine for maintenance of blood pressure and cardiac output during spinal anesthesia for cesarean delivery: A double-blinded randomized study.","volume":"136","author":"Belin","year":"2023","journal-title":"Anesth Analg."},{"key":"B25","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1097\/ALN.0000000000002483","article-title":"Norepinephrine infusion for preventing postspinal anesthesia hypotension during cesarean delivery: A randomized dose-finding trial.","volume":"130","author":"Hasanin","year":"2019","journal-title":"Anesthesiology."},{"key":"B26","doi-asserted-by":"publisher","first-page":"CD002251","DOI":"10.1002\/14651858.CD002251.pub4","article-title":"Techniques for preventing hypotension during spinal anaesthesia for caesarean section.","volume":"7","author":"Chooi","year":"2020","journal-title":"Cochrane Database Syst Rev."},{"key":"B27","doi-asserted-by":"publisher","first-page":"74","DOI":"10.1177\/0310057X1504300111","article-title":"Effect of different phenylephrine bolus doses for treatment of hypotension during spinal anaesthesia in patients undergoing elective caesarean section.","volume":"43","author":"Mohta","year":"2015","journal-title":"Anaesth Intensive Care."},{"key":"B28","doi-asserted-by":"publisher","first-page":"509","DOI":"10.1097\/CM9.0000000000000621","article-title":"Bolus norepinephrine and phenylephrine for maternal hypotension during elective cesarean section with spinal anesthesia: A randomized, double-blinded study.","volume":"133","author":"Wang","year":"2020","journal-title":"Chin Med J (Engl)."}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1421947\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,10]],"date-time":"2025-07-10T13:39:37Z","timestamp":1752154777000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1421947\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,9]]},"references-count":28,"alternative-id":["10.3389\/fmed.2025.1421947"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2025.1421947","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,9]]},"article-number":"1421947"}}