Effect of delayed supine positioning after induction of spinal anaesthesia for caesarean section.
BACKGROUND
The study tested the hypothesis that the incidence of hypotension during spinal anaesthesia for caesarean section is less in parturients who remain in the sitting position for 3 min compared with parturients who are placed in the modified supine position immediately after induction of spinal anesthesia.


METHODS
Spinal anaesthesia was induced with the woman in the sitting position using 2.8 ml hyperbaric bupivacaine 0.5% at the L(3-4) or L(2-3) interspace. Ninety-eight patients scheduled for elective caesarean section under spinal anaesthesia were randomised to assume the supine position on an operating table tilted 10 degrees to the left (modified supine position) immediately after spinal injection (group 0, n=52) or to remain in the sitting position for 3 min before they also assumed the modified supine position (group 3, n=46). Isotonic saline 2-300 ml was given intravenously over 15 min before spinal injection followed by 15 ml/kg over 15-20 min after induction of spinal anaesthesia. If the systolic blood pressure decreased to less than 70% of baseline or to less than 100 mmHg or if there was any complaint of nausea, ephedrine was given in 5 mg boluses intravenously every 2 min.


RESULTS
The blood pressure decreased significantly in both groups following spinal injection (P<0.001). Blood pressure variations over time differed significantly between the two groups (P<0.05). However, the incidence of maternal hypotension before delivery was similar in the two groups. The difference was caused by the time to the blood pressure nadir being significantly shorter in group 0 compared with group 3 (9.1+/-4.5 min vs. 11.7+/-3.7 min, P<0.01). Similar numbers of patients received rescue with ephedrine before delivery: 35 (67%) in group 0 vs. 26 (57%) in group 3 (NS). The mean total dose of ephedrine before delivery was 10.9 mg in group 0 vs. 9.2 mg in group 3 (NS). There were no differences in neonatal outcome between the two groups.


CONCLUSIONS
At elective caesarean section, a 3-min delay before supine positioning does not influence the incidence of maternal hypotension after induction of spinal anaesthesia in the sitting position with 2.8 ml of bupivacaine 0.5% with 8% dextrose.
Køhler
F
F
Department of Anesthesiology and Intensive Care Medicine, Odense University Hospital, Denmark. flemming.koehler@ouh.fyns-amt.dk
Sørensen
J F
JF
Helbo-Hansen
H S
HS
D000328:Adult; D000773:Anesthesia, Obstetrical; D000775:Anesthesia, Spinal; D000779:Anesthetics, Local / Q000493:pharmacokinetics; D001794:Blood Pressure / Q000502:physiology; D002045:Bupivacaine / Q000493:pharmacokinetics; D002585:Cesarean Section; D004809:Ephedrine / Q000493:pharmacokinetics; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007022:Hypotension / Q000503:physiopathology*; D007231:Infant, Newborn; D007431:Intraoperative Complications / Q000503:physiopathology*; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology; D011247:Pregnancy; D011256:Pregnancy Outcome; D016683:Supine Position / Q000502:physiology*; D014662:Vasoconstrictor Agents / Q000493:pharmacokinetics
D000779:Anesthetics, Local; D014662:Vasoconstrictor Agents; D004809:Ephedrine; D002045:Bupivacaine