Yonsei Med J.  2015 Jul;56(4):1122-1127. 10.3349/ymj.2015.56.4.1122.

Head Elevation in Spinal-Epidural Anesthesia Provides Improved Hemodynamics and Appropriate Sensory Block Height at Caesarean Section

• Lee MH
• Kim EM
• Bae JH
• Park SH
• Chung MH
• Choi YR
• Choi EM

• KMID: 2366356
• DOI: http://doi.org/10.3349/ymj.2015.56.4.1122

Abstract

PURPOSE
We aimed to determine whether head elevation during combined spinal-epidural anesthesia (CSE) and Caesarean section provided improved hemodynamics and appropriate sensory block height.
MATERIALS AND METHODS
Forty-four parous women undergoing CSE for elective Caesarean section were randomly assigned to one of two groups: right lateral (group L) or right lateral and head elevated (group HE) position, for insertion of the block. Patients were positioned in the supine wedged position (group L) or the left lateral and head elevated position (group HE) until a block height of T5 to light touch was reached. Group HE was then turned to the supine wedged position with maintenance of head elevation until the end of surgery. Hemodynamics, including the incidence of hypotension, ephedrine dose required, and characteristics of the sensory blocks were analyzed.
RESULTS
The incidence of hypotension (16 versus 7, p=0.0035) and the required dose of ephedrine [24 (0-40) versus 0 (0-20), p<0.0001] were greater in group L compared to group HE. In group L, the time to achieve maximal sensory block level (MSBL) was shorter (11.8+/-5.4 min versus 20.1+/-6.3 min, p<0.0001) and MSBL was also higher than in group HE [14 (T2) versus 12 (T4), p=0.0015].
CONCLUSION
Head elevation during CSE and Caesarean section is superior to positioning without head elevation in the lateral to supine position, as it is associated with a more gradual onset, appropriate block height, and improved hemodynamics.

Keyword

Anesthesia obstetrical; anesthesia spinal; Caesarean section

MeSH Terms

Adult
Anesthesia, Epidural/*methods
Anesthesia, Obstetrical/*methods
Anesthesia, Spinal/*methods
Blood Pressure/physiology
Cesarean Section/*methods
Elective Surgical Procedures/methods
Female
Head
Hemodynamics
Humans
Hypotension
Patient Positioning/*methods
Pregnancy
Treatment Outcome

Figure

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  Fig. 1 Flow chart of patients enrolled and dropped-out in the two groups.

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  Fig. 2 Number of dermatomes blocked after subarachnoid injection of 10 mg of 0.5% bupivacaine and 10 μg of fentanyl in the lateral and head elevated (group HE) and lateral (group L) position groups. Dermatome 1=L3; 12=T4; 14=T2 of sensory block level. *p<0.05.

• 

  Fig. 3 Changes in mean arterial pressure (MAP, A) and heart rate (HR, B) after subarachnoid injection of 10 mg of 0.5% bupivacaine and 10 μg of fentanyl in the lateral and head elevated (group HE) and lateral (group L) position groups. *p<0.05 compared with baseline value in each group. B, baseline; BL, baseline lateral.

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