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.
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Authors | Hilde C Coppejans, Ellen Hendrickx, Joris Goossens, Marcel P Vercauteren |
Journal | Anesthesia and analgesia
(Anesth Analg)
Vol. 102
Issue 1
Pg. 243-7
(Jan 2006)
ISSN: 1526-7598 [Electronic] United States |
PMID | 16368837
(Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial)
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Topics |
- Adult
- Anesthesia, Epidural
(methods)
- Anesthesia, Spinal
(methods)
- Cesarean Section
(methods)
- Female
- Humans
- Hypotension
(epidemiology, physiopathology)
- Infant, Newborn
- Nerve Block
(methods)
- Posture
(physiology)
- Pregnancy
- Prospective Studies
- Severity of Illness Index
- Supine Position
(physiology)
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