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The sitting versus right lateral position during combined spinal-epidural anesthesia for cesarean delivery: block characteristics and severity of hypotension.
Anesth Analg. 2006 Jan; 102(1):243-7.A&A

Abstract

In the present study we evaluated whether the sitting position during initiation of small-dose combined spinal-epidural anesthesia (CSE) would induce less hypotension as compared with the lateral position. Sixty women undergoing elective cesarean delivery were randomly assigned to receive a spinal injection consisting of 6.6 mg hyperbaric bupivacaine with sufentanil 3.3 microg in either the lateral or the sitting position. After securing the epidural catheter, patients were turned to a 15 degrees left lateral supine position. Ephedrine 5 mg IV was administered prophylactically and subsequently in case of nausea/vomiting and/or hypotension, defined as a systolic blood pressure less than 95 mm Hg or a 25% decrease from baseline values. Although the incidence of ephedrine supplementation was not different, females in the sitting group required less ephedrine (P = 0.012) and there were fewer problems with identifying the epidural space (P = 0.01). However, more patients in this group required epidural supplementation (35% versus 3%; P = 0.007). In the lateral group, blocks extended more cephalad than with the sitting position (P = 0.014). Apgar scores did not differ, but umbilical artery pH values were significantly higher in patients of the sitting group (7.31 +/- 0.04 versus 7.26 +/- 0.03; P = 0.02). We conclude that performing a CSE technique for cesarean delivery in the sitting position was technically easier and induced less severe hypotension.

Authors+Show Affiliations

Department of Anesthesia, University Hospital Antwerp, Edegem, Belgium.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

16368837

Citation

Coppejans, Hilde C., et al. "The Sitting Versus Right Lateral Position During Combined Spinal-epidural Anesthesia for Cesarean Delivery: Block Characteristics and Severity of Hypotension." Anesthesia and Analgesia, vol. 102, no. 1, 2006, pp. 243-7.
Coppejans HC, Hendrickx E, Goossens J, et al. The sitting versus right lateral position during combined spinal-epidural anesthesia for cesarean delivery: block characteristics and severity of hypotension. Anesth Analg. 2006;102(1):243-7.
Coppejans, H. C., Hendrickx, E., Goossens, J., & Vercauteren, M. P. (2006). The sitting versus right lateral position during combined spinal-epidural anesthesia for cesarean delivery: block characteristics and severity of hypotension. Anesthesia and Analgesia, 102(1), 243-7.
Coppejans HC, et al. The Sitting Versus Right Lateral Position During Combined Spinal-epidural Anesthesia for Cesarean Delivery: Block Characteristics and Severity of Hypotension. Anesth Analg. 2006;102(1):243-7. PubMed PMID: 16368837.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The sitting versus right lateral position during combined spinal-epidural anesthesia for cesarean delivery: block characteristics and severity of hypotension. AU - Coppejans,Hilde C, AU - Hendrickx,Ellen, AU - Goossens,Joris, AU - Vercauteren,Marcel P, PY - 2005/12/22/pubmed PY - 2006/1/19/medline PY - 2005/12/22/entrez SP - 243 EP - 7 JF - Anesthesia and analgesia JO - Anesth Analg VL - 102 IS - 1 N2 - In the present study we evaluated whether the sitting position during initiation of small-dose combined spinal-epidural anesthesia (CSE) would induce less hypotension as compared with the lateral position. Sixty women undergoing elective cesarean delivery were randomly assigned to receive a spinal injection consisting of 6.6 mg hyperbaric bupivacaine with sufentanil 3.3 microg in either the lateral or the sitting position. After securing the epidural catheter, patients were turned to a 15 degrees left lateral supine position. Ephedrine 5 mg IV was administered prophylactically and subsequently in case of nausea/vomiting and/or hypotension, defined as a systolic blood pressure less than 95 mm Hg or a 25% decrease from baseline values. Although the incidence of ephedrine supplementation was not different, females in the sitting group required less ephedrine (P = 0.012) and there were fewer problems with identifying the epidural space (P = 0.01). However, more patients in this group required epidural supplementation (35% versus 3%; P = 0.007). In the lateral group, blocks extended more cephalad than with the sitting position (P = 0.014). Apgar scores did not differ, but umbilical artery pH values were significantly higher in patients of the sitting group (7.31 +/- 0.04 versus 7.26 +/- 0.03; P = 0.02). We conclude that performing a CSE technique for cesarean delivery in the sitting position was technically easier and induced less severe hypotension. SN - 1526-7598 UR - https://www.unboundmedicine.com/medline/citation/16368837/The_sitting_versus_right_lateral_position_during_combined_spinal_epidural_anesthesia_for_cesarean_delivery:_block_characteristics_and_severity_of_hypotension_ L2 - https://doi.org/10.1213/01.ane.0000189049.11005.26 DB - PRIME DP - Unbound Medicine ER -