title: Head Elevation in Spinal-Epidural Anesthesia Provides Improved Hemodynamics and Appropriate Sensory Block Height at Caesarean Section.
abstract: OBJECTIVE
  We aimed to determine whether head elevation during combined spinal-epidural anesthesia (CSE) and Caesarean section provided improved hemodynamics and appropriate sensory block height.
  
  
  METHODS
  Forty-four parous women undergoing CSE for elective Caesarean section were randomly assigned to one of two groups: right lateral (group L) or right lateral and head elevated (group HE) position, for insertion of the block. Patients were positioned in the supine wedged position (group L) or the left lateral and head elevated position (group HE) until a block height of T5 to light touch was reached. Group HE was then turned to the supine wedged position with maintenance of head elevation until the end of surgery. Hemodynamics, including the incidence of hypotension, ephedrine dose required, and characteristics of the sensory blocks were analyzed.
  
  
  RESULTS
  The incidence of hypotension (16 versus 7, p=0.0035) and the required dose of ephedrine [24 (0-40) versus 0 (0-20), p<0.0001] were greater in group L compared to group HE. In group L, the time to achieve maximal sensory block level (MSBL) was shorter (11.8±5.4 min versus 20.1±6.3 min, p<0.0001) and MSBL was also higher than in group HE [14 (T2) versus 12 (T4), p=0.0015].
  
  
  CONCLUSIONS
  Head elevation during CSE and Caesarean section is superior to positioning without head elevation in the lateral to supine position, as it is associated with a more gradual onset, appropriate block height, and improved hemodynamics.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
authors.forename: Mi Hyeon
authors.initials: MH
authors.lastname: Lee
authors.affiliation: Department of Anesthesiology and Pain Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
authors.forename: Eun Mi
authors.initials: EM
authors.lastname: Kim
authors.affiliation: Department of Anesthesiology and Pain Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
authors.forename: Jun Hyeon
authors.initials: JH
authors.lastname: Bae
authors.affiliation: Department of Obstetrics and Gynecology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
authors.forename: Sung Ho
authors.initials: SH
authors.lastname: Park
authors.affiliation: Department of Anesthesiology and Pain Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
authors.forename: Mi Hwa
authors.initials: MH
authors.lastname: Chung
authors.affiliation: Department of Anesthesiology and Pain Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
authors.forename: Young Ryong
authors.initials: YR
authors.lastname: Choi
authors.affiliation: Department of Anesthesiology and Pain Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea. emchoi96@hallym.or.kr.
authors.forename: Eun Mi
authors.initials: EM
authors.lastname: Choi
mesh_terms: D000328:Adult; D000767:Anesthesia, Epidural / Q000379:methods*; D000773:Anesthesia, Obstetrical / Q000379:methods*; D000775:Anesthesia, Spinal / Q000379:methods*; D001794:Blood Pressure / Q000502:physiology; D002585:Cesarean Section / Q000379:methods*; D017558:Elective Surgical Procedures / Q000379:methods; D005260:Female; D006257:Head; D006439:Hemodynamics; D006801:Humans; D007022:Hypotension; D056888:Patient Positioning / Q000379:methods*; D011247:Pregnancy; D016896:Treatment Outcome
keywords: Anesthesia obstetrical; Caesarean section; anesthesia spinal