Maternal cardiovascular consequences of positioning after spinal anaesthesia for Caesarean section: left 15 degree table tilt vs. left lateral.
Sixty healthy women undergoing elective Caesarean section were randomly allocated to either a measured 15 degrees left table tilt position (n = 31) or full left lateral position (n = 29) for a 15-min period after spinal blockade. Arm and leg blood pressure, ephedrine requirements, symptoms, fetal heart rate, cord gases and Apgar scores were recorded. Mean ephedrine requirements and incidence of hypotension were similar in the two groups. Arm systolic arterial pressure over time was similar in both groups, but leg systolic arterial pressure over time was significantly lower in the tilt group (p < 0.001); the mean leg systolic arterial pressure was lower for all 15 sequential recordings in the tilt group, reaching statistical significance (p < 0.05) at 4, 5, 6 and 8 min. Differences in maternal nausea, vomiting and bradycardia and fetal outcome were not statistically significant. Following spinal anaesthesia, even a true 15 degrees left table tilt position is associated with aortic compression.
Rees
S G O
SG
Department of Anaesthesia, St Michael's Hospital, Southwell Street, Bristol BS2 8EG, UK. sgorees@tuatara2.demon.co.uk
Thurlow
J A
JA
Gardner
I C
IC
Scrutton
M J L
MJ
Kinsella
S M
SM
D000328:Adult; D000773:Anesthesia, Obstetrical / Q000379:methods*; D000775:Anesthesia, Spinal; D001794:Blood Pressure / Q000187:drug effects; D004334:Drug Administration Schedule; D004809:Ephedrine / Q000008:administration & dosage; D005260:Female; D006340:Heart Rate, Fetal / Q000187:drug effects; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D011187:Posture / Q000502:physiology*; D011247:Pregnancy; D011446:Prospective Studies; D014662:Vasoconstrictor Agents / Q000008:administration & dosage
D014662:Vasoconstrictor Agents; D004809:Ephedrine