A Randomized Crossover Study to Determine the Effect of a 30° Head-Up Versus a Supine Position on the Functional Residual Capacity of Term Parturients

Hignett, Rachel; Fernando, Roshan; McGlennan, Alan; McDonald, Sarah D.; Stewart, Adrienne; Columb, Malachy O.; Adamou, Tina; Dilworth, Paul

doi:10.1213/ane.0b013e31822bf1d2

Cited by 40 publications

(19 citation statements)

References 22 publications

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“…Similar results have been published by comparing the FRC difference between the 30°BC and S position in a population of full-term pregnant women. 27 Leg position in the RT might help to unload the diaphragm and increase FRC by accentuating excursion through the ventilation trial. Conversely, the present results differ from that showed an absence of FRC variation between the S and 30°RT position in mildly to moderately obese subjects (BMI 30 to 39.9 kgÁm -2 ).…”

Section: Discussionmentioning

confidence: 99%

Effect of position and positive pressure ventilation on functional residual capacity in morbidly obese patients: a randomized trial

Couture

Provencher

Somma

et al. 2018

Can J Anesth/J Can Anesth

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Section: Discussionmentioning

confidence: 99%

Effect of position and positive pressure ventilation on functional residual capacity in morbidly obese patients: a randomized trial

Couture

Provencher

Somma

et al. 2018

Can J Anesth/J Can Anesth

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“…[32][33][34][35] Essentially the parturient desaturates twice as fast as a nonpregnant woman (139 ± 13 vs. 58 ± 8 mm Hg/min). The effects on FRC and oxygenation consumption combine at term pregnancy and in the immediate postpartum period, to give a significantly reduced oxygenated apnea time.…”

Section: Parturient Anatomy and Physiologymentioning

confidence: 99%

Obstetric Airway Management

Preston

Jee

2014

International Anesthesiology Clinics

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“…In addition to lateral uterine displacement as indicated, the head-up position should be considered. A [20][21][22][23][24][25][26][27][28][29][30] o head-up position increases functional residual capacity in pregnant women [53] and safe apnoea time in nonpregnant obese and non-obese patients [54][55][56][57]. It also decreases difficulty with insertion of the laryngoscope caused by large breasts, improves the view at laryngoscopy [58] and may reduce gastro-oesophageal reflux [59].…”

Section: Rapid Sequence Inductionmentioning

confidence: 99%

Obstetric Anaesthetists’ Association and Difficult Airway Society Guidelines for the Management of Difficult and Failed Tracheal Intubation in Obstetrics

Mushambi¹,

Kinsella²,

Popat³

et al. 2016

Obstetric Anesthesia Digest

114

221

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SummaryThe Obstetric Anaesthetists' Association and Difficult Airway Society have developed the first national obstetric guidelines for the safe management of difficult and failed tracheal intubation during general anaesthesia. They comprise four algorithms and two tables. A master algorithm provides an overview. Algorithm 1 gives a framework on how to optimise a safe general anaesthetic technique in the obstetric patient, and emphasises: planning and multidisciplinary communication; how to prevent the rapid oxygen desaturation seen in pregnant women by advocating nasal oxygenation and mask ventilation immediately after induction; limiting intubation attempts to two; and consideration of early release of cricoid pressure if difficulties are encountered. Algorithm 2 summarises the management after declaring failed tracheal intubation with clear decision points, and encourages early insertion of a (preferably secondgeneration) supraglottic airway device if appropriate. Algorithm 3 covers the management of the 'can't intubate, can't oxygenate' situation and emergency front-of-neck airway access, including the necessity for timely perimortem caesarean section if maternal oxygenation cannot be achieved. Table 1 gives a structure for assessing the individual factors relevant in the decision to awaken or proceed should intubation fail, which include: urgency related to maternal or fetal factors; seniority of the anaesthetist; obesity of the patient; surgical complexity; aspiration risk; potential difficulty with provision of alternative anaesthesia; and post-induction airway device and airway patency. This decision should be considered by the team in advance of performing a general anaesthetic to make a provisional plan should failed intubation occur. The table is also intended to be used as a teaching tool to facilitate discussion and learning regarding the complex nature of decision-making when faced with a failed intubation. Table 2 gives practical considerations of how to awaken or proceed with surgery. The background paper covers recommendations on drugs, new equipment, teaching and training.

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A Randomized Crossover Study to Determine the Effect of a 30° Head-Up Versus a Supine Position on the Functional Residual Capacity of Term Parturients

Abstract: We have demonstrated that the FRC of healthy term parturients increases significantly in the 30° head-up position in comparison with supine.

Cited by 40 publications

References 22 publications

Effect of position and positive pressure ventilation on functional residual capacity in morbidly obese patients: a randomized trial

Effect of position and positive pressure ventilation on functional residual capacity in morbidly obese patients: a randomized trial

Obstetric Airway Management

Obstetric Anaesthetists’ Association and Difficult Airway Society Guidelines for the Management of Difficult and Failed Tracheal Intubation in Obstetrics

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