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• W2938727308 abstract "To the Editor Several issues are raised by Tawfik et al1 in their study of preloading for and coloading during spinal anesthesia. First, the authors used the diameter of inferior vena cava, measured by ultrasonography, as an indicator of volume status. Although appealing as a noninvasive method, its validity has yet to be established in this setting. During spontaneous breathing, the inferior vena cava collapses during inspiration due to the negative intrathoracic pressure generated. The degree of collapse is, therefore, dependent on the strength of the inspiration and not just the degree of venous filling. Obstetric patients are often anxious and hyperventilate. The increased inspiratory effort will overestimate the degree of collapse. Second, the authors justify their approach by stating that “IVC diameters and calculation of the IVC-CI provide a reliable noninvasive tool for assessment of the central venous pressure” and go on to state that central venous pressure (CVP) is used in “prediction of fluid responsiveness in critically ill patients” and can be used in “guidance of intraoperative fluid and vasopressor management in high-risk patients.” Both of these statements may be true in very specific settings, but their universal application should be questioned. Multiple studies have demonstrated a lack of connection between CVP and volume status.2 No longer should CVP be used to guide management in high-risk patients as demonstrated in its exclusion from the surviving sepsis guidelines. We believe that the phenomenon observed of increased blood pressure during the active loading of fluid is a demonstration of the often unrecognized Bayliss effect (or the Bayliss myogenic response), which was first described by Bayliss3 in 1902. This is the response of vascular smooth muscle to stretch. The distension of blood vessels, particularly arterioles, as occurs during a rapid fluid bolus, stimulates a myogenic reflex and constriction of blood vessels, resulting in increased peripheral resistance and hence increased blood pressure. This little recognized phenomenon is often also seen during acute illnesses such as bleeding or sepsis. During the active phase of fluid administration, the blood pressure climbs or stabilizes. As soon as the infusion is stopped, the myogenic contraction releases and the blood pressure falls. This is often misinterpreted as a sign of volume responsiveness, explains the relative ineffectiveness of fluid bolus therapy,4 and leads to volume overload. Do the authors agree that the appropriate treatment for spinal anesthesia-induced vasodilatation in a normovolemic patient is a vasoconstrictor and fluid loading is often inappropriate, particularly in high-risk obstetric cases? Coloading is probably not harmful in low-risk patients but is unnecessary. Ellis Muggleton, BMedSci (Hons), MBChB (Hons), MRCP, EDICTülin Muggleton, MDDepartment of Anesthesiology and Intensive Care MedicineKlinikum rechts der IsarTechnical University of MunichMunich, Germany[email protected]" @default.
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• W2938727308 date "2019-06-01" @default.
• W2938727308 modified "2023-09-24" @default.
• W2938727308 title "Routine Fluid Coloading During Spinal Anesthesia Should Be Abandoned" @default.
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• W2938727308 doi "https://doi.org/10.1213/ane.0000000000004160" @default.
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