| Objective:Combined spinal-epidural anesthesia (CSEA) is associated with a greater incidence of hypotension in the pregnant woman and no single method has proven to be effective. In order to identify the role of the maternal positions in the hypotension after the induction of CSEA, we investigated the effect of maternal fully left lateral vs.30°left tilt supine position on the incidence and severity of hypotension.Methods:Sixty six pregnant women undergoing elective Caesarean section were randomly divided into two groups:LL Group:CSEA was performed with the needle bevel oriented laterally in the full left lateral position and remained them in the same position until the ready for surgery (n=33); LS Group:CSEA was performed with the needle oriented laterally and then turned them to a30°left tilt supine position (n=33); Record the changes in blood pressure and sensory block level within20mins after the spinal anesthesia、the usage of intraoperative ephedrine、the adverse reaction of nausea and vomiting and umbilical arterial blood gas analysis(BE value and pH value).Results:Ephedrine requirements were less in the full left lateral position group than in the other position:median (range) doses for the LL and LS were0(0-6),6(0-24) mg predilivery, and0(0-0),0(0-12) mg postdelivery, respectively; p<0.05. There was no significant difference in block level between dependent and nondependent sides in the lateral group.Conclusions:Our study revealed that patient position play an important role in the development of hypotension in cesarean patients. Injection of10.0mg hyperbaric ropivacaine and sufentanil5μg with the bevel of the Whitacre needle oriented laterally and remained the women in the full left lateral position until ready for surgery is a new type of anesthesia for caesarean section, which does not produce unilateral blockade. It not only provide satisfied block for surgical incision, but also produce better haemodynamic stability. |
PDF Full Text Request