Combined spinal epidural anaesthesia for caesarean section: a randomised comparison of Oxford, lateral and sitting positions

Comparison of Maternal and Neonatal Effects of Combined Spinal Epidural Anesthesia in the Sitting or Lateral Position During Elective Cesarean Section

“…In studies, in which hemodynamic effects of maternal position was compared, independent from the severity of hypotension, 1-and 5-minutes Apgar scores are similar in lateral and sitting positions (11,18,19,21,23). Similarly, in our study, besides no difference was found between the groups, none of the newborns had a 1-and 5-minutes Apgar score <7.…”

“…Although Russell et al (19) found that hemodynamic parameters and ephedrine consumption when using 12.5 mg hyperbaric bupivacaine and 12.5 µg fentanyl in CSE anaesthesia was similar in right lateral decubitus and sitting position for caesarean section, ephedrine requirement which was 18 mg (0-60 mg) in the sitting position was 12 mg (0-42 mg) in right lateral decubitus position. In the same study, after spinal injection the time from epidural catheter placement to the positioning of the parturient was 3.25 minutes in sitting position and 3.18 minutes in lateral position; the corresponding figures were 1.8 minutes and 1.9 minutes, respectively, in our study.…”

“…In the literature, the studies using 6.6, 12 mg and 12.5 mg hyperbaric bupivacaine, reported the maximum mean sensory block level in sitting position as T2-T3, and in lateral decubitus position as T1-T3 (11,18,19). Spinal anaesthesia using the same local anaesthetic agent in the same dose and volume can lead to different levels of sensory block according to the changes in the baricity of the local anaesthetic agent.…”

Patient safety and quality: can anaesthetists play a greater role?

“…In five out of 38 women in the tilt position, hypotension was corrected merely by increasing the amount of tilt from 12°to 20°. It was noted that, at the point that women managed lateral after the spinal are repositioned supine with tilt prior to CS, further doses of ephedrine may be required [14][15][16]. This tends to cancel out the lower use of ephedrine just after the spinal, although it may be easier to manage hypotension from a single cause rather than that resulting from a combination of evolving spinal as well as inferior vena cava compression.…”

“…Anaesthetists must take a wider perspective outside the operating theatre to secure quality outcomes for surgical patients. Lee pointed out that failure to provide an appropriate medical intervention through underuse, overuse or misuse should be considered as 'error', that is, such failure is an issue of safety as well as of quality [16]. Anaesthetists do not always act as part of a team working to reduce common causes of morbidity and mortality for surgical patients.…”