Hypotension following combined spinal-epidural anaesthesia for Caesarean section: left lateral position vs. tilted supine position

C. Mendonca¹, J. Griffiths² , B. Aţeleanu³, R. E. Collis³
1) Consultant, Department of Anaesthesia, Walsgarave Hospital, Coventry. 2) Consultant, Department of Anaesthesia, Royal Gwent Hospital, Newport. 3) Consultant, Department of Anaesthesia, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK

Abstract

Eighty-seven pregnant mothers undergoing elective Caesarean section were randomly allocated either to the full left lateral position (n = 45) or to the supine position with 12° left lateral tilt (n= 42) after a combined spinal-epidural (CSE) in the sitting position and an initial 2 min in the full right lateral position. Fewer mothers were hypotensive while in the study position [29 (64%) in the lateral group vs. 38 (90%) in the tilted supine group; p = 0.03]. Mothers in the lateral group tended to become hypotensive after turning them back to the tilted supine position immediately before surgery; hence the number of mothers who were hypotensive from the insertion of the CSE until delivery were similar [36 (80%) vs. 38 (90%)]. Mothers in the lateral group required a lower dose of ephedrine to treat their hypotension while in their study position {median (interquartile range [range]) 6 (0-12 [0-36]) mg vs. 12 (6-18 [0-36]) mg, respectively; p = 0.04} but ephedrine requirements were similar overall {12 (6—12 [0-36]) mg vs. 12 (6-18 [0-36]) mg}, respectively. The full left lateral position reduces the incidence of early hypotension compared with the tilted supine position with tilt, and makes it easier to treat.

Keywords: anaesthesia, obstetric, anaesthetic techniques, combined spinal-epidural, complications, hypotension, surgery, caesarean section

Hipotensiunea postanestezie combinată rahidiană-peridurală (CSE) pentru operaţia cezariană (o comparaţie între poziţia de decubit lateral stâng complet şi poziţia de decubit dorsal cu 12° înclinaţie laterală stângă)

Jurnalul Român de Anestezie Terapie intensivă 2005 Vol.12 Nr.2, 115-119