Intravenous Fluid Bolus Prior to Initiation of Epidural Analgesia in Preeclamptic Patients

Abstract

Purpose: The purpose of this project was to develop clear guidelines and increase safety for the preeclamptic parturients receiving labor epidurals and to protect their infants. Recommendations were elicited from seasoned practitioners of obstetrical (OB) anesthesia to establish parameters to guide fluid management decisions, recommend a specific volume range and type of fluid to be given, and recommend how best to treat hypotension caused by sympathectomy.

Methods: A cross-sectional survey design was used. Certified Registered Nurse Anesthetists from Michigan and Indiana who regularly provide OB anesthesia were asked multiple choice and open-ended questions via an online survey (Qualtrics) to elicit recommendations on caring for preeclamptic and severely preeclamptic parturients receiving a labor epidural.

Results: Nearly half (49.25%) of respondents recommended administering an IV fluid bolus prior to labor epidural placement in preeclamptic parturients. Another 44.78% listed factors such as blood pressure, fluid status, physical status or current symptoms, and renal function, as factors they consider before deciding on an IV fluid bolus. Both groups recommended administering an IV fluid bolus of 462 ml to 604 ml of a crystalloid solution. Twenty-six percent recommended treating hypotension in the preeclamptic parturient if mother or the fetus is symptomatic. Given a choice of multiple treatment options, over 75% of the experts recommended administering crystalloid, ephedrine, or phenylephrine to correct hypotension.

Conclusions: CRNAs experts in the field of high-risk OB responded overwhelmingly positively to pretreating a preeclamptic parturient with an IV fluid bolus prior to administering a labor epidural. Anesthesia providers should feel confident administering a modest IV fluid bolus to mitigate hypotension caused by vasodilation from a labor epidural.

Keywords: preeclampsia, labor epidural, fluid bolus, preload, hypotension