Guideline-recommended 15° left lateral table tilt during cesarean section in regional anesthesia-practical aspects: An observational study.
OBJECTIVE
Left lateral table tilt of 15° to 30° is recommended for cesarean section, although little is known about the practical problems of its implementation. This study examines these issues from the perspective of anesthesiologists, obstetricians, theater nurses, and patients. Initially, the tilt was set by visual estimation in 100 women and checked by inclinometer afterwards.


METHODS
Observational survey.


METHODS
One hundred women undergoing primary cesarean section.


METHODS
The anesthesiologist's initial estimated tilt setting was documented, then patient comfort and obstetrician's needs were assessed at 15°, and the tilt was adjusted accordingly. Problems were identified, and possible solutions were introduced. The effects of our solutions were reevaluated after 12months.


RESULTS
Despite appropriate training, too little tilt was achieved in most cases. Even with objective inclinometry, complaints by patients, obstetricians, and theater nurses made physicians reluctant to press for 15° tilt. Better compliance was achieved by the introduction of a 2-step tilt procedure, side bar mounting, and inclinometry. After 12months, 96% of anesthesiologists were using the inclinometer to set at least 10°. Most observed an improvement in patient care.


CONCLUSIONS
Implementation of 10° to 15° tilt requires objective inclinometry. It allows tilt adjustment to be made by interdisciplinary staff in greater confidence that patient comfort and surgical conditions will not be impaired. Strategies to reduce discomfort are presented in this article.
Department of Anaesthesiology and Intensive Care, Philipps-University of Marburg UKGM StO. Marburg, Baldingerstrasse D-35033 Marburg, Germany. Electronic address: aust@staff.uni-marburg.de.
Hansjoerg
H
Aust
Department of Obstetrics and Perinatal Medicine, Philipps-University of Marburg UKGM StO. Marburg, Baldingerstrasse D-35033 Marburg, Germany.
Sigmund
S
Koehler
Department of Obstetrics and Perinatal Medicine, Philipps-University of Marburg UKGM StO. Marburg, Baldingerstrasse D-35033 Marburg, Germany.
Maritta
M
Kuehnert
Department of Anaesthesiology and Intensive Care, Philipps-University of Marburg UKGM StO. Marburg, Baldingerstrasse D-35033 Marburg, Germany.
Thomas
T
Wiesmann
D000765:Anesthesia, Conduction; D000773:Anesthesia, Obstetrical; D001291:Attitude of Health Personnel; D002585:Cesarean Section; D005260:Female; D006801:Humans; D058638:Operating Tables; D056888:Patient Positioning / Q000379:methods*; D017410:Practice Guidelines as Topic; D011795:Surveys and Questionnaires
Anesthesia; Cesarean section; Obstetrical; Patient positioning