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Preanesthetic ultrasonography assessment of inferior vena cava diameter (IVCD) in the supine position (SP), left lateral tilt position (LLT), and with the left uterine displacement maneuver (LUD) in full‐term pregnant women: a randomized cross‐over design study.AimWe pre‐anesthetically measured IVCD using ultrasonography in the SP, LLT, and the LUD in full‐term pregnant women, using a cross‐over design, to evaluate the effectiveness of LLT and LUD on increasing IVCD, and the presence of inter‐individual differences among patients in the effect of posture on IVCD.MethodsTwenty‐two parturients scheduled for elective cesarean section under spinal anesthesia were recruited. All patients were sequentially placed in the SP, LLT, and with LUD before spinal anesthesia induction. Indices of IVCD, measured by subxiphoid ultrasonography, including maximum IVCD (IVCDmax), minimum IVCD (IVCDmin), and collapsibility index (CI) were recorded in each of the postures. Mean or median values of all measurements were compared among the postures.ResultsThe mean values of IVCDmax observed with both LLT and LUD were significantly larger than those in the SP, respectively (SP vs. LLT: p < 0.05, SP vs. LUD: p < 0.01), although there were no significant differences between IVCDmax with LLT and LUD. There were no significant differences in IVCDmin and CI between any of the postures. IVCDmax was highest with LUD in 11 patients (55%), in the LLT in seven patients (35%) and in the SP in two patients (10%).ConclusionsLLT and LUD might be equally effective in enlarging the narrowed IVCD as compared to SP. However, both LLT and LUD might not necessarily be appropriate treatments to relieve IVC compression in some cases.

Although the efficacy rate of epidural analgesia during labor and delivery in Japan is lower for various reasons than that in Western countries, the number of pregnant women who want painless delivery is gradually increasing. To meet a growing need for obstetric analgesia for labor and delivery in our hospital, our team consisting of anesthesiologists, gynecologists, birthing assistants and medical processors has started to provide analgesia for labor since last year, and the number of cases has been steadily increasing. For safe and effective analgesia, we deliberately discussed and prepared a manual to use mainly combined spinal and epidural anesthesia for initial analgesia, followed by a combination of patient-controlled analgesia and programmed intermittent epidural bolus. Importantly, all perinatal staff should be aware of both anesthesia-related and delivery-related complications and communicate how to adequately treat them to facilitate safe and smooth delivery.

BackgroundWe used preanesthetic ultrasonography evaluation to study the effectiveness of left lateral tilt position (LLT) and the left uterine displacement maneuver (LUD) on increasing inferior vena cava diameter (IVCD) in healthy full-term pregnant women, using a randomized, single blinded, cross-over design study.MethodsTwenty-two parturients scheduled for elective cesarean section under spinal anesthesia were recruited. All patients were sequentially placed in the supine position (SPN), LLT and with LUD before induction of spinal anesthesia. Indices of IVCD, measured by subxiphoid ultrasonography, including maximum IVCD (IVCDmax), minimum IVCD (IVCDmin) and collapsibility index (CI), and hemodynamic parameters, such as heart rate and blood pressure, were recorded in each of the postures. Mean or median values of all measurements were compared among the postures.ResultsThe mean values of IVCDmax observed with both LLT and LUD were significantly larger than those in the SPN, respectively (SPN vs. LLT: P <0.05, SPN vs. LUD: P <0.01), although there were no significant differences between IVCDmax with LLT and LUD. There were no significant differences in IVCDmin, CI and hemodynamic parameters between any of the postures. IVCDmax was highest with LUD in 11 patients (55%), in the LLT position in seven patients (35%) and in the SPN in two patients (10%).ConclusionsLLT and LUD might be equally effective in enlarging the narrowed IVCD as compared to SPN. However, both LLT and LUD might not necessarily be appropriate treatment to relieve IVC compression in some cases.Trial registrationThis study was registered in the “UMIN Clinical Trials Registry” (ID no.: 000024344, date. 10th October 2016).