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Effects of sitting up for five minutes versus immediately lying down after spinal anesthesia for Cesarean delivery on fluid and ephedrine requirement; a randomized trial.
Can J Anaesth. 2011 Dec; 58(12):1083-9.CJ

Abstract

BACKGROUND

Patient position after spinal anesthesia has had variable effects on blood pressure and ephedrine requirements. The aim of this study was to determine the effects that sitting the patient up for five minutes after spinal anesthesia would have on intraoperative fluid and ephedrine requirements.

METHODS

The study included 120 women at term gestation who were scheduled for Cesarean delivery under spinal anesthesia. After anesthetic administration, the women were randomized either to sit up for five minutes then lie down (Group S) or to lie down immediately (Group L) to a tilted supine position. A blinded observer recorded sensory block level, systolic blood pressure, heart rate, ephedrine and fluid requirements, adverse events, and time to motor recovery (modified Bromage score of 2).

RESULTS

Group S had a lower intraoperative sensory block height than Group L [T4 (1) vs T2 (1), respectively; P < 0.001]; Group S also required less ephedrine (8% vs 47%, respectively; P < 0.001), received less fluid [709 (59) mL vs 789 (90) mL, respectively; P < 0.001], and experienced less nausea and vomiting (5% vs 22%, respectively; P = 0.014) and shortness of breath (3% vs 28%, respectively; P < 0.001) intraoperatively. In Group S, the odds of requiring ephedrine were 0.09 compared with 0.89 in Group L (odds ratio 0.10). There were no differences in systolic blood pressure (P = 0.127) or heart rate (P = 0.831) over time between groups. Time to a modified Bromage score of 2 was longer in Group S than in Group L [101 (15) min vs 88 (14) min, respectively; P < 0.001].

CONCLUSIONS

Sitting the patient up for five minutes rather than laying the patient down immediately after spinal anesthesia for Cesarean delivery decreased intraoperative sensory block height, ephedrine and fluid requirements, and intraoperative nausea, vomiting, and shortness of breath without affecting systolic blood pressure or the success of the anesthetic. However, the method resulted in delayed postoperative motor recovery.

Authors+Show Affiliations

Department of Anesthesia & Critical Care, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

21971743

Citation

El-Hakeem, Essam E Abd, et al. "Effects of Sitting Up for Five Minutes Versus Immediately Lying Down After Spinal Anesthesia for Cesarean Delivery On Fluid and Ephedrine Requirement; a Randomized Trial." Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie, vol. 58, no. 12, 2011, pp. 1083-9.
El-Hakeem EE, Kaki AM, Almazrooa AA, et al. Effects of sitting up for five minutes versus immediately lying down after spinal anesthesia for Cesarean delivery on fluid and ephedrine requirement; a randomized trial. Can J Anaesth. 2011;58(12):1083-9.
El-Hakeem, E. E., Kaki, A. M., Almazrooa, A. A., Al-Mansouri, N. M., & Alhashemi, J. A. (2011). Effects of sitting up for five minutes versus immediately lying down after spinal anesthesia for Cesarean delivery on fluid and ephedrine requirement; a randomized trial. Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie, 58(12), 1083-9. https://doi.org/10.1007/s12630-011-9593-4
El-Hakeem EE, et al. Effects of Sitting Up for Five Minutes Versus Immediately Lying Down After Spinal Anesthesia for Cesarean Delivery On Fluid and Ephedrine Requirement; a Randomized Trial. Can J Anaesth. 2011;58(12):1083-9. PubMed PMID: 21971743.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of sitting up for five minutes versus immediately lying down after spinal anesthesia for Cesarean delivery on fluid and ephedrine requirement; a randomized trial. AU - El-Hakeem,Essam E Abd, AU - Kaki,Abdullah M, AU - Almazrooa,Adnan A, AU - Al-Mansouri,Nisma M, AU - Alhashemi,Jamal A, Y1 - 2011/10/05/ PY - 2011/07/09/received PY - 2011/09/12/accepted PY - 2011/10/6/entrez PY - 2011/10/6/pubmed PY - 2012/6/13/medline SP - 1083 EP - 9 JF - Canadian journal of anaesthesia = Journal canadien d'anesthesie JO - Can J Anaesth VL - 58 IS - 12 N2 - BACKGROUND: Patient position after spinal anesthesia has had variable effects on blood pressure and ephedrine requirements. The aim of this study was to determine the effects that sitting the patient up for five minutes after spinal anesthesia would have on intraoperative fluid and ephedrine requirements. METHODS: The study included 120 women at term gestation who were scheduled for Cesarean delivery under spinal anesthesia. After anesthetic administration, the women were randomized either to sit up for five minutes then lie down (Group S) or to lie down immediately (Group L) to a tilted supine position. A blinded observer recorded sensory block level, systolic blood pressure, heart rate, ephedrine and fluid requirements, adverse events, and time to motor recovery (modified Bromage score of 2). RESULTS: Group S had a lower intraoperative sensory block height than Group L [T4 (1) vs T2 (1), respectively; P < 0.001]; Group S also required less ephedrine (8% vs 47%, respectively; P < 0.001), received less fluid [709 (59) mL vs 789 (90) mL, respectively; P < 0.001], and experienced less nausea and vomiting (5% vs 22%, respectively; P = 0.014) and shortness of breath (3% vs 28%, respectively; P < 0.001) intraoperatively. In Group S, the odds of requiring ephedrine were 0.09 compared with 0.89 in Group L (odds ratio 0.10). There were no differences in systolic blood pressure (P = 0.127) or heart rate (P = 0.831) over time between groups. Time to a modified Bromage score of 2 was longer in Group S than in Group L [101 (15) min vs 88 (14) min, respectively; P < 0.001]. CONCLUSIONS: Sitting the patient up for five minutes rather than laying the patient down immediately after spinal anesthesia for Cesarean delivery decreased intraoperative sensory block height, ephedrine and fluid requirements, and intraoperative nausea, vomiting, and shortness of breath without affecting systolic blood pressure or the success of the anesthetic. However, the method resulted in delayed postoperative motor recovery. SN - 1496-8975 UR - https://www.unboundmedicine.com/medline/citation/21971743/Effects_of_sitting_up_for_five_minutes_versus_immediately_lying_down_after_spinal_anesthesia_for_Cesarean_delivery_on_fluid_and_ephedrine_requirement L2 - https://doi.org/10.1007/s12630-011-9593-4 DB - PRIME DP - Unbound Medicine ER -