a b s t r a c tMaternal hypotension is a common complication after spinal anesthesia for cesarean delivery. Prevention and treatment of post-spinal hypotension (PSH) in cesarean delivery has been frequently investigated.Fluid loading is superior to no-fluid regimen; however, the incidence of PSH is still high with all fluid loading protocols; thus, the use of fluid loading as a sole method for prophylaxis might be not satisfactory for many anesthetists. Phenylephrine is the preferred vasopressor for prevention and management of PSH in most cases. Ephedrine may be more beneficial in patients with bradycardia, patients with uteroplacental insufficiency and pre-eclamptic patients. Norepinephrine infusion was recently investigated as an alternative for prophylaxis of PSH with minimal cardiac side effects.The high incidence of PSH with most of the pharmacological and non-pharmacological methods suggests the need for multimodal protocols for prevention and management of this problem. PSH in cesarean delivery is a common daily situation facing all anesthetists; thus, future research should focus on simple and rapid protocols that can be easily applied by anesthetists with moderate and low experience with minimal need to complex devices or costly drugs.
BackgroundMaternal hypotension is a common complication after spinal anesthesia for cesarean section (CS). In this study we investigated the role of leg elevation (LE) as a method for prevention of post-spinal hypotension (PSH) for cesarean section.MethodsOne hundred and fifty full term parturients scheduled for CS were included in the study. Patients were randomized into two groups: Group LE (leg elevation group, n = 75) and group C (Control group, n = 75). Spinal block was performed in sitting position after administration of 10 mL/Kg Ringer’s lactate as fluid preload. After successful intrathecal injection of local anesthetic, Patients were positioned in the supine position. Leg elevation was performed for LE group directly after spinal anesthesia and maintained till skin incision. Intraoperative hemodynamic parameters (Arterial blood pressure and heart rate), intra-operative ephedrine consumption, incidence of PSH, and incidence of nausea and vomiting were reported.ResultsLE group showed lower incidence of PSH (34.7% Vs 58.7%, P = 0.005) compared to the control group. Arterial blood pressure was higher in the LE group compared to the control group in the first two readings after spinal block. Other readings showed comparable arterial blood pressure and heart rate values between both study groups; however, LE showed less ephedrine consumption (4.9 ± 7.8 mg Vs 10 ± 11 mg, P = 0.001).ConclusionLE performed immediately after spinal block reduced the incidence of PSH in parturients undergoing CS.Trial registrationThe study was registered at Pan African Clinical Trials Registry system on 5/10/2015 with trial number PACTR201510001295348.
BackgroundPost-spinal hypotension is a common maternal complication during cesarean delivery. Aortocaval compression by the gravid uterus has been assumed as a precipitating factor for post-spinal hypotension. The role of left lateral tilting position in improving maternal cardiac output after subarachnoid block (SAB) is unclear. The aim of this work is to investigate the effect of left lateral tilting on maternal hemodynamics after SAB.MethodsA prospective observational study was conducted including 105 full term pregnant women scheduled for cesarean delivery. Mean arterial pressure, heart rate, cardiac output (measured by electrical cardiometry), stroke volume, and systemic vascular resistance were recorded in three positions (supine, 150, and 300 left lateral positions) before SAB, after SAB, and after delivery of the fetus.ResultsBefore SAB, no significant hemodynamic changes were reported with left lateral tilting. A significant decrease was reported in mean arterial pressure, cardiac output, stroke volume, and systemic vascular resistance after SAB (in supine position). When performing left lateral tilting, there was an increase in cardiac output, heart rate, and mean arterial pressure. No difference was reported between the two tilt angles (150 and 300).ConclusionsChanging position of full term pregnant woman after SAB from supine to left lateral tilted position results increased cardiac output and mean arterial pressure. There is no difference between the two tilt angles (150 and 300).Trial registrationclinicaltrials.gov (NCT02828176) retrospectively registered.
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