Turkiye Klinikleri Journal of Anesthesiology Reanimation

.: ORIGINAL RESEARCH
Investigating Maternal Effects of Positions Applied in Patients Preparing for Caesarean Section Under Spinal Anesthesia: A Prospective Randomized Clinical Study
Spinal Anestezi Altında Sezaryen Doğuma Hazırlanan Hastalarda Uygulanan POzisyonların Maternal Etkilerinin Araştırılması: Prospektif Randomize Klinik Çalışma
Ferdi GÜLAŞTIa , Sercan KANTARCIb
aAdnan Menderes University Faculty of Medicine, Department of Anesthesiology and Reanimation, Aydın, Türkiye
bTepecik Training and Research Hospital, Clinic of Obstetrics and Gynecology, İzmir, Türkiye
Turkiye Klinikleri J Anest Reanim. 2024;22(2):31-8
doi: 10.5336/anesthe.2023-99201
Article Language: EN
Full Text
ABSTRACT
 Objective: The effectiveness of placing patients in a 15° left-lateral tilt position (LLTP) during the surgical preparation to prevent hypotension after spinal anesthesia in cesarean surgeries is discussed today, and it has not been elucidated whether it is beneficial or not. In recent years, it has been considered that more effective results can be obtained with the 30° LLTP for the patients during surgical preparation. The purpose of the present study was to compare whether there is a difference between maternal effects of supine, 15° left tilt, and 30° left tilt positions. Material and Methods: Women who underwent elective cesarean delivery under spinal anesthesia were randomized to the supine position (SP), 15° LLTP, or 30° LLTP groups. The position was changed to supine before the incision and 10 mL/kg of isotonic fluid was initiated in the patients. Hypotension [systolic blood pressure (SBP) reduction >20% baseline or SBP<90 mmHg] was treated with intravenous bolus ephedrine based on maternal heart rate. The incidence of hypotension and bradycardia until the end of surgery, as well as the time to first ephedrine use and the total amount of ephedrine administered, were investigated. Results: Time of first ephedrine HCl use was earlier in the SP group compared to the 30° left tilt position group (3 vs. 6 minutes, p=0.002). The total dose of ephedrine HCl was significantly lower in the SP group than in the 30° left tilt position group (p<0.001). Conclusion: Hypotension development can be averted in term pregnant women when they stay in the 30° LLTP after spinal anesthesia.

Keywords: Cesarean section; spinal anesthesia; tilt position
ÖZET
 Amaç: Sezaryen ameliyatlarında spinal anestezi sonrası hipotansiyonu önlemek için cerrahi hazırlık sırasında hastaların 15° sola tilt pozisyonunda yerleştirilmesinin etkinliği günümüzde tartışılmakta olup, faydalı olup olmadığı henüz aydınlatılamamıştır. Son yıllarda hastalara cerrahi hazırlık sırasında 30° sola tilt pozisyonu verilmesiyle daha etkili sonuçlar alınabileceği düşünülmektedir. Bu çalışmanın amacı, sırtüstü 15° sola eğim ve 30° sola eğim pozisyonlarının anneye etkileri arasında fark olup olmadığını karşılaştırmaktır. Gereç ve Yöntemler: Spinal anestezi altında elektif sezaryen doğum yapılan kadınlar sırtüstü pozisyon, 15° sol-lateral tilt pozisyonu veya 30° sol-lateral tilt pozisyonu gruplarına randomize edildi. Kesi öncesi pozisyon supin pozisyona getirilerek hastalara 10 mL/kg izotonik sıvı başlandı. Hipotansiyon (sistolik kan basıncında başlangıca göre >%20 azalma veya <90 mm Hg), annenin kalp atış hızına göre intravenöz bolus efedrin ile tedavi edildi. Ameliyat sonuna kadar hipotansiyon ve bradikardi görülme sıklığı ile ilk efedrin kullanım zamanı ve toplam efedrin miktarı araştırıldı. Bulgular: Efedrin HCl'nin ilk kullanım zamanı sırtüstü pozisyon grubunda 30° sola tilt pozisyonuna göre daha erkendi (3'e karşı 6 dk, p=0,002). Toplam efedrin HCl dozu sırtüstü pozisyon grubunda 30° sola tilt pozisyonuna göre anlamlı derecede fazlaydı (p<0,001). Sonuç: Term gebelerde spinal anestezi sonrası 30° sola tilt pozisyonunda kalmaları durumunda hipotansiyon gelişmesi önlenebilir.

Anahtar Kelimeler: Sezaryen ameliyatı; spinal anestezi; tilt pozisyon
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