title: The sitting versus right lateral position during combined spinal-epidural anesthesia for cesarean delivery: block characteristics and severity of hypotension.
abstract: In the present study we evaluated whether the sitting position during initiation of small-dose combined spinal-epidural anesthesia (CSE) would induce less hypotension as compared with the lateral position. Sixty women undergoing elective cesarean delivery were randomly assigned to receive a spinal injection consisting of 6.6 mg hyperbaric bupivacaine with sufentanil 3.3 microg in either the lateral or the sitting position. After securing the epidural catheter, patients were turned to a 15 degrees left lateral supine position. Ephedrine 5 mg IV was administered prophylactically and subsequently in case of nausea/vomiting and/or hypotension, defined as a systolic blood pressure less than 95 mm Hg or a 25% decrease from baseline values. Although the incidence of ephedrine supplementation was not different, females in the sitting group required less ephedrine (P = 0.012) and there were fewer problems with identifying the epidural space (P = 0.01). However, more patients in this group required epidural supplementation (35% versus 3%; P = 0.007). In the lateral group, blocks extended more cephalad than with the sitting position (P = 0.014). Apgar scores did not differ, but umbilical artery pH values were significantly higher in patients of the sitting group (7.31 +/- 0.04 versus 7.26 +/- 0.03; P = 0.02). We conclude that performing a CSE technique for cesarean delivery in the sitting position was technically easier and induced less severe hypotension.
authors.affiliation: Department of Anesthesia, University Hospital Antwerp, Edegem, Belgium.
authors.forename: Hilde C
authors.initials: HC
authors.lastname: Coppejans
authors.forename: Ellen
authors.initials: E
authors.lastname: Hendrickx
authors.forename: Joris
authors.initials: J
authors.lastname: Goossens
authors.forename: Marcel P
authors.initials: MP
authors.lastname: Vercauteren
mesh_terms: D000328:Adult; D000767:Anesthesia, Epidural / Q000379:methods*; D000775:Anesthesia, Spinal / Q000379:methods*; D002585:Cesarean Section / Q000379:methods*; D005260:Female; D006801:Humans; D007022:Hypotension / Q000453:epidemiology* / Q000503:physiopathology; D007231:Infant, Newborn; D009407:Nerve Block / Q000379:methods*; D011187:Posture / Q000502:physiology; D011247:Pregnancy; D011446:Prospective Studies; D012720:Severity of Illness Index; D016683:Supine Position / Q000502:physiology