title: A randomized crossover study to determine the effect of a 30° head-up versus a supine position on the functional residual capacity of term parturients.
abstract: BACKGROUND
  Airway management continues to pose challenges to the obstetric anesthesiologist. Functional residual capacity (FRC), which acts as an oxygen reservoir, is reduced from the second trimester onwards and is exacerbated in the supine position. Mechanisms to increase FRC may delay the onset of hypoxemia during periods of apnea. Values for changes in FRC in term parturients in semierect positions are unknown. We hypothesized that the FRC of healthy term parturients would increase significantly in the 30° head-up position in comparison with the supine position.
  
  
  METHODS
  Twenty-two healthy term parturients were recruited. Initial screening spirometry was performed to exclude undiagnosed respiratory disease. FRC was measured using the helium dilution technique in the supine, 30° head-up, and sitting erect positions. Subjects were randomized to sequence of position testing order. Noninvasive systolic blood pressure, heart rate, and oxygen saturation were measured twice in each testing position.
  
  
  RESULTS
  Results from 20 subjects were analyzed. The spirometry results for all subjects were within predicted normal reference intervals. FRC measurements differed significantly (P<0.001) among all positions. FRC increased by a mean of 188 mL (95% confidence interval 18 to 358 mL) from the supine to the 30° head-up position (P=0.03). There were no significant differences in vital signs among testing positions (P>0.16).
  
  
  CONCLUSIONS
  We have demonstrated that the FRC of healthy term parturients increases significantly in the 30° head-up position in comparison with supine.
authors.affiliation: Department of Anesthesia, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: Rachel
authors.initials: R
authors.lastname: Hignett
authors.forename: Roshan
authors.initials: R
authors.lastname: Fernando
authors.forename: Alan
authors.initials: A
authors.lastname: McGlennan
authors.forename: Sarah
authors.initials: S
authors.lastname: McDonald
authors.forename: Adrienne
authors.initials: A
authors.lastname: Stewart
authors.forename: Malachy
authors.initials: M
authors.lastname: Columb
authors.forename: Tina
authors.initials: T
authors.lastname: Adamou
authors.forename: Paul
authors.initials: P
authors.lastname: Dilworth
mesh_terms: D000328:Adult; D001794:Blood Pressure / Q000502:physiology; D001827:Body Height / Q000502:physiology; D016001:Confidence Intervals; D018592:Cross-Over Studies; D036861:Delivery, Obstetric; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D005652:Functional Residual Capacity / Q000502:physiology*; D006339:Heart Rate / Q000502:physiology; D006371:Helium; D006801:Humans; D010100:Oxygen / Q000097:blood; D011187:Posture / Q000502:physiology*; D011247:Pregnancy; D013147:Spirometry; D016683:Supine Position / Q000502:physiology*; D055815:Young Adult
chemical_list: D006371:Helium; D010100:Oxygen