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Combined spinal epidural anesthesia in obese parturients undergoing cesarean surgery : A single-blinded randomized comparison of lateral decubitus and sitting positions.
Anaesthesist. 2021 12; 70(Suppl 1):30-37.A

Abstract

BACKGROUND

There is a significant increase in number of obese pregnant women worldwide. Obese parturients undergoing cesarean section have a higher risk for hypotension and require higher doses of vasopressors following spinal anesthesia compared to nonobese parturients.

OBJECTIVE

This study aimed to compare the maternal hemodynamic changes when combined spinal-epidural anesthesia (CSEA) is induced in the left lateral decubitus and sitting positions in obese pregnant women undergoing elective cesarean section.

MATERIAL AND METHODS

In this study, pregnant women with full-term gestation diagnosed as obese undergoing elective cesarean section were included. Two groups were formed: the CSEA was performed in left lateral position in group I (n = 50) and in sitting position in group II (n = 50). At the end of the CSEA procedure, patients were placed in the supine position. When the sensory block reached at the upper level of T6 dermatome, surgery was initiated. Hemodynamic, anesthetic and neonatal parameters were recorded.

RESULTS

In all patients, CSEA was successful and sufficient anesthesia was provided for surgery. Time to reach T6 dermatome sensory level in group II was found to be longer than group I (P = 0.011). At 20 min after spinal injection, the maximum sensory block level was similar in both groups. There were no significant differences between groups in terms of sensory block time and the time to requiring postoperative supplemental analgesics. There were no significant differences in terms of the volume of intravenous fluid administered, ephedrine and atropine requirements between groups. Both groups had similar systolic blood pressure, heart rate and oxygen saturation values during surgery and postoperatively. While both groups had similar diastolic blood pressure (DBP) values during surgery and at the 1st postoperative hour, group II had lower DBP values at the 2nd postoperative hour compared with group I (P = 0.04).

CONCLUSION

Left lateral decubitus and sitting positions during performance of CSEA lead to similar maternal hemodynamic changes in obese pregnant women undergoing cesarean section.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Okucu F
Department of Anesthesiology and Reanimation, Faculty of Medicine, Ataturk University, 25240, Erzurum, Turkey.
Aksoy M
Department of Anesthesiology and Reanimation, Faculty of Medicine, Ataturk University, 25240, Erzurum, Turkey. drmaksoy@hotmail.com. Anesthesiology Clinical Research Office, Ataturk University, Erzurum, Turkey. drmaksoy@hotmail.com.
Ince I
Department of Anesthesiology and Reanimation, Faculty of Medicine, Ataturk University, 25240, Erzurum, Turkey. Anesthesiology Clinical Research Office, Ataturk University, Erzurum, Turkey.
Aksoy AN
Department of Obstetrics and Gynecology, Erzurum Regional Training and Research Hospital, University of Health Sciences, Erzurum, Turkey.
Dostbıl A
Department of Anesthesiology and Reanimation, Faculty of Medicine, Ataturk University, 25240, Erzurum, Turkey. Anesthesiology Clinical Research Office, Ataturk University, Erzurum, Turkey.
Ozmen O
Department of Anesthesiology and Reanimation, Faculty of Medicine, Ataturk University, 25240, Erzurum, Turkey. Anesthesiology Clinical Research Office, Ataturk University, Erzurum, Turkey.

MeSH

Anesthesia, EpiduralAnesthesia, ObstetricalAnesthesia, SpinalCesarean SectionFemaleHumansHypotensionInfant, NewbornObesityPregnancySitting Position

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

34159412

Citation

Okucu, Fatma, et al. "Combined Spinal Epidural Anesthesia in Obese Parturients Undergoing Cesarean Surgery : a Single-blinded Randomized Comparison of Lateral Decubitus and Sitting Positions." Der Anaesthesist, vol. 70, no. Suppl 1, 2021, pp. 30-37.
Okucu F, Aksoy M, Ince I, et al. Combined spinal epidural anesthesia in obese parturients undergoing cesarean surgery : A single-blinded randomized comparison of lateral decubitus and sitting positions. Anaesthesist. 2021;70(Suppl 1):30-37.
Okucu, F., Aksoy, M., Ince, I., Aksoy, A. N., Dostbıl, A., & Ozmen, O. (2021). Combined spinal epidural anesthesia in obese parturients undergoing cesarean surgery : A single-blinded randomized comparison of lateral decubitus and sitting positions. Der Anaesthesist, 70(Suppl 1), 30-37. https://doi.org/10.1007/s00101-021-00995-8
Okucu F, et al. Combined Spinal Epidural Anesthesia in Obese Parturients Undergoing Cesarean Surgery : a Single-blinded Randomized Comparison of Lateral Decubitus and Sitting Positions. Anaesthesist. 2021;70(Suppl 1):30-37. PubMed PMID: 34159412.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Combined spinal epidural anesthesia in obese parturients undergoing cesarean surgery : A single-blinded randomized comparison of lateral decubitus and sitting positions. AU - Okucu,Fatma, AU - Aksoy,Mehmet, AU - Ince,Ilker, AU - Aksoy,Ayse Nur, AU - Dostbıl,Aysenur, AU - Ozmen,Ozgur, Y1 - 2021/06/22/ PY - 2021/01/21/received PY - 2021/05/01/accepted PY - 2021/04/18/revised PY - 2021/6/24/pubmed PY - 2022/2/3/medline PY - 2021/6/23/entrez KW - Cesarean section KW - Hypotension KW - Neuraxial anesthesia KW - Obesity KW - Position SP - 30 EP - 37 JF - Der Anaesthesist JO - Anaesthesist VL - 70 IS - Suppl 1 N2 - BACKGROUND: There is a significant increase in number of obese pregnant women worldwide. Obese parturients undergoing cesarean section have a higher risk for hypotension and require higher doses of vasopressors following spinal anesthesia compared to nonobese parturients. OBJECTIVE: This study aimed to compare the maternal hemodynamic changes when combined spinal-epidural anesthesia (CSEA) is induced in the left lateral decubitus and sitting positions in obese pregnant women undergoing elective cesarean section. MATERIAL AND METHODS: In this study, pregnant women with full-term gestation diagnosed as obese undergoing elective cesarean section were included. Two groups were formed: the CSEA was performed in left lateral position in group I (n = 50) and in sitting position in group II (n = 50). At the end of the CSEA procedure, patients were placed in the supine position. When the sensory block reached at the upper level of T6 dermatome, surgery was initiated. Hemodynamic, anesthetic and neonatal parameters were recorded. RESULTS: In all patients, CSEA was successful and sufficient anesthesia was provided for surgery. Time to reach T6 dermatome sensory level in group II was found to be longer than group I (P = 0.011). At 20 min after spinal injection, the maximum sensory block level was similar in both groups. There were no significant differences between groups in terms of sensory block time and the time to requiring postoperative supplemental analgesics. There were no significant differences in terms of the volume of intravenous fluid administered, ephedrine and atropine requirements between groups. Both groups had similar systolic blood pressure, heart rate and oxygen saturation values during surgery and postoperatively. While both groups had similar diastolic blood pressure (DBP) values during surgery and at the 1st postoperative hour, group II had lower DBP values at the 2nd postoperative hour compared with group I (P = 0.04). CONCLUSION: Left lateral decubitus and sitting positions during performance of CSEA lead to similar maternal hemodynamic changes in obese pregnant women undergoing cesarean section. SN - 1432-055X UR - https://www.unboundmedicine.com/medline/citation/34159412/Combined_spinal_epidural_anesthesia_in_obese_parturients_undergoing_cesarean_surgery_:_A_single_blinded_randomized_comparison_of_lateral_decubitus_and_sitting_positions_ DB - PRIME DP - Unbound Medicine ER -

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