Hemodynamic effects of lateral tilt before and after spinal anesthesia during cesarean delivery: an observational study

Abstract

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.

Comparison of two Norepinephrine rescue bolus for Management of Post-spinal Hypotension during Cesarean Delivery: a randomized controlled trial

“…There is a variable incidence of hypotension among previous reports in which vasopressor prophylaxis was used during cesarean delivery; this incidence ranged between 2% [14] and 49% [15]. We also acknowledge that the incidence of hypotension in the current study was lower than that reported in our studies in which no vasopressor was used for prophylaxis (∼ 60%) [16,17]. Therefore, we assume that using vasopressor prophylaxis would decrease the incidence of maternal hypotension compared to novasopressor protocols.…”

Effects of continuous infusion of phenylephrine vs. norepinephrine on parturients and fetuses under LiDCOrapid monitoring: A randomized, double-blind, placebo-controlled study

“…3,4 According to recent studies, SA-induced hypotension occurs in 80% of all parturients and nearly 60% of in-term parturients during CD without prophylactic use of vasopressors due to sympathetic blockade by the anesthesia. 5,6 Thus, obstetric anesthetists increasingly opt for prophylactic vasopressor use for routine prevention of post-SA hypotension during CD. 7 In recent years, the optimization of hemodynamics, particularly post-SA hypotension during CD, remains the critical management challenge for anesthesiologists.…”

Effect of leg wrapping technique on prevention of spinal induced hypotension and fetal acidosis during cesarean section: Randomized controlled trial

“…Moreover, Hasanin et al [18] concluded that the changing position of Egyptian parturients after the subarachnoid block from supine to left lateral tilted position leading to increased cardiac output and mean arterial pressure. There is no difference between both tilt angles (15 degrees and 30 degrees).…”