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Impact of leg elevation added to a 15˚ left lateral incline on maternal hypotension and neonatal outcomes in cesarean section: A randomized clinical study

Year 2019, Volume: 3 Issue: 9, 689 - 693, 01.09.2019

Feyza Bolcal Çalışır Aykut Urfalıoğlu Neşe Yücel Hafize Öksüz Gözen Öksüz Adem Doğaner Ömer Faruk Boran

https://doi.org/10.28982/josam.559641

Abstract

Aim: The supine position can cause maternofetal complications by exacerbating hypotension resulting from spinal anesthesia (SA). The aim of this study was to investigate and compare the effect of positioning the patient with a 15˚ left lateral incline and both positioning and elevating both legs on SA-induced hypotension. 

Methods: This randomized clinical study was conducted on 200 pregnant women who underwent cesarean section in a university hospital between November 1, 2016 and April 15, 2017.

Pregnant women were separated into 2 groups as the 15˚ left lateral incline (Group 1) and the 15˚ left lateral incline and leg elevation group (Group 2). Mean arterial blood pressure (MAP) and heart rate (HR) values, ephedrine use, neonatal APGAR scores and umbilical cord vein blood gas analysis samples were compared at varying times. After administration of SA, MAP and HR were recorded at the second, fourth, sixth, eighth and tenth minutes until delivery of the infant, every five minutes after delivery until the 30th postpartum minute, and at the end of the surgery. 

Results: Two and four minutes after the administration of SA and 20 minutes after delivery, mean HR values of group 2 were significantly higher than that of group 1 (P=0.002, P=0.005, P=0.006, respectively). MAP values were similar in both groups at all time points, however, a greater number of patients in group 1 had MAP <60 mmHg and HR <60 bpm at two and six minutes after the administration of SA. 

Conclusion: Positioning the table at a 15˚ incline and leg elevation during ceasarian section may provide maternofetal benefits by reducing the frequency of post-spinal hypotension in pregnant women.

Keywords

Pregnancy Cesarean section Spinal anesthesia Hypotension

References

  • 1. Sak S, Peker N, Uyanıkoglu H, Binici O, İncebıyık A, Sak ME. Which should be performed; general or spinal anesthesia in elective cesarean section? Med Bull Zeynep Kamil. 2018;49(1):44-8.
  • 2. Ramanathan J, Bennett K. Pre-eclampsia: fluids, drugs, and anesthetic management. Anesthesiol Clin North Am. 2003;21(1):145-63.
  • 3. Tsen LC. Anesthesia for cesarean delivery. In: Chestnut DH, Wong CA, Tsen LC et al, edS. Chestnut’s Obstetric Anesthesia: Principles and Practice, 5th ed. Philadelpia (PA): Elsevier Academic Press; 2014. pp. 545-603.
  • 4. Pederson H, Finster M. Selection and use of local anesthetics. Clin Obstet Gynecol. 1987;30(3):505-14.
  • 5. Cousins MJ, Bridenbaugh PO. Neural blockade in clinical anesthesia and management of pain. Vol. 494. Philadelpia (PA); Lippincott-Raven; 1998.
  • 6. Greene NM. Distribution of local anesthetic solutions within the subarachnoid space. Anesth Analg. 1985;64(7):715-30.
  • 7. Frölich MA. Obstetric Anesthesia. In: Butterworth JF, Mackey DC, Wasnick JD, eds. Morgan & Mikhail’s Clinical Anesthesiology, 5th ed. New York (NY): McGraw- Hill; 2013. pp. 843-76.
  • 8. Guay J. The effect of neuraxial blocks on surgical blood loss and blood transfusion requirements: a meta-analysis. J Clin Anesth. 2006;18(2):124-8.
  • 9. Richman JM, Rowlingson AJ, Maine DN, Courpas GE, Weller JF, Wu CL. Does neuraxial anesthesia reduce intraoperative blood loss? A meta-analysis. J Clin Anesth. 2006;18(6):427-35.
  • 10. Rocke DA, Rout CC. Volume preloading, spinal hypotension and caesarean section. Br J Anaesth. 1995;75(3):257-9.
  • 11. Singh K, Payal YS, Sharma JP, Nautiyal R. Evaluation of hemodynamic changes after leg wrapping in elective cesarean section under spinal anesthesia. J Obstet Anaesth Crit Care. 2014;4(1):23-8.
  • 12. Hasanin A, Aiyad A, Elsakka A, Kamel A, Fouad R, Osman M et al. Leg elevation decreases the incidence of post-spinal hypotension in cesarean section: a randomized controlled trial. BMC Anesthesiol. 2017;17(1):60.
  • 13. Lee SW, Khaw KS, Ngan Kee WD, Leung TY, Critchley LA. Haemodynamic effects from aortocaval compression at different angles of lateral tilt in non-labouring term pregnant women. Br J Anaesth. 2012;109(6):950-6.
  • 14. Obasuyi BI, Fyneface-Ogan S, Mato CN. A comparison of the haemodynamic effects of lateral and sitting positions during induction of spinal anaesthesia for caesarean section. Int J Obstet Anesth. 2013;22(2):124-8.
  • 15. Reynolds F, Seed PT. Anaesthesia for caesarean section and neonatal acid-base status: a meta-analysis. Anaesthesia. 2005;60(7):636-53.
  • 16. Critchley, LA, Short TG, Gin T. Hypotension during subarachnoid anaesthesia: haemodynamic analysis of three treatments. Br J Anaesth. 1994;72(2):151-5.

Sezaryen seksiyolarda 15˚ sol lateral eğime eklenen bacak elevasyonunun maternal hipotansiyon ve yenidoğan sonuçları üzerine etkisi: Randomize klinik çalışma

Year 2019, Volume: 3 Issue: 9, 689 - 693, 01.09.2019

Feyza Bolcal Çalışır Aykut Urfalıoğlu Neşe Yücel Hafize Öksüz Gözen Öksüz Adem Doğaner Ömer Faruk Boran

https://doi.org/10.28982/josam.559641

Abstract

Amaç: Sırtüstü pozisyon, spinal anesteziden (SA) kaynaklanan hipotansiyonu arttırarak maternofetal komplikasyonlara neden olabilir. Bu çalışmanın amacı, SA uygulanan sezaryenlerde 15˚ sol lateral eğim ve bacak elevasyonu yöntemlerinin, SA'nın oluşturduğu hipotansiyon üzerine etkilerini araştırmaktır.

Yöntemler: Randomize klinik bu çalışma 1 Kasım 2016 ile 15 Nisan 2017 tarihleri arasında bir üniversite hastanesinde sezaryen uygulanan 200 gebede yapıldı.

Gebeler, 15˚ sol lateral eğim (grup 1) ve 15˚ sol lateral eğim+bacak elevasyon grubu (grup 2) olarak 2 gruba ayrıldı. Hastaların değişik zamanlardaki ortalama arter kan basıncı (OAB) ve kalp atım hızı (KAH) değerleri, efedrin kullanımları ile neonatal APGAR skorları ve umblikal kord veni kan gazı analiz örnekleri karşılaştırıldı. SA uygulamasından sonra OAB ve KAH değerleri, bebeğin doğumuna kadar 2, 4, 6, 8, 10. dakikalar ve doğumdan sonra her 5 dakikada bir kaydedildi. Benzer şekilde, bu değerler doğum sonrası 5, 10, 15, 20, 25, 30. dakikalar ve cerrahi bitiminde değerlendirildi.

Bulgular: SA uygulamasından 2-4 dakika sonra, KAH değerlerinin grup 2'de anlamlı derecede yüksek olduğu belirlendi (sırasıyla; P=0,002, P=0,005). OAB değerleri her iki grupta tüm zaman noktalarında benzer olup, doğumdan 20 dakika sonraki KAH değerleri grup 2'de yüksekti (P=0,006). Bebeğin doğumundan önce SA’den 2-6. dakikalar sonrasındaki, OAB <60 mmHg ve KAH <60 atım olan hasta sayısı grup 1'de daha fazla idi.

Sonuç: Masanın 15˚'lik bir eğimde konumlandırması ve bacakların elevasyonu, gebelerde postspinal hipotansiyon sıklığını azaltarak maternofetal faydalar sağlayabilir.

Keywords

Gebelik Sezaryen Spinal anestezi Hipotansiyon

References

  • 1. Sak S, Peker N, Uyanıkoglu H, Binici O, İncebıyık A, Sak ME. Which should be performed; general or spinal anesthesia in elective cesarean section? Med Bull Zeynep Kamil. 2018;49(1):44-8.
  • 2. Ramanathan J, Bennett K. Pre-eclampsia: fluids, drugs, and anesthetic management. Anesthesiol Clin North Am. 2003;21(1):145-63.
  • 3. Tsen LC. Anesthesia for cesarean delivery. In: Chestnut DH, Wong CA, Tsen LC et al, edS. Chestnut’s Obstetric Anesthesia: Principles and Practice, 5th ed. Philadelpia (PA): Elsevier Academic Press; 2014. pp. 545-603.
  • 4. Pederson H, Finster M. Selection and use of local anesthetics. Clin Obstet Gynecol. 1987;30(3):505-14.
  • 5. Cousins MJ, Bridenbaugh PO. Neural blockade in clinical anesthesia and management of pain. Vol. 494. Philadelpia (PA); Lippincott-Raven; 1998.
  • 6. Greene NM. Distribution of local anesthetic solutions within the subarachnoid space. Anesth Analg. 1985;64(7):715-30.
  • 7. Frölich MA. Obstetric Anesthesia. In: Butterworth JF, Mackey DC, Wasnick JD, eds. Morgan & Mikhail’s Clinical Anesthesiology, 5th ed. New York (NY): McGraw- Hill; 2013. pp. 843-76.
  • 8. Guay J. The effect of neuraxial blocks on surgical blood loss and blood transfusion requirements: a meta-analysis. J Clin Anesth. 2006;18(2):124-8.
  • 9. Richman JM, Rowlingson AJ, Maine DN, Courpas GE, Weller JF, Wu CL. Does neuraxial anesthesia reduce intraoperative blood loss? A meta-analysis. J Clin Anesth. 2006;18(6):427-35.
  • 10. Rocke DA, Rout CC. Volume preloading, spinal hypotension and caesarean section. Br J Anaesth. 1995;75(3):257-9.
  • 11. Singh K, Payal YS, Sharma JP, Nautiyal R. Evaluation of hemodynamic changes after leg wrapping in elective cesarean section under spinal anesthesia. J Obstet Anaesth Crit Care. 2014;4(1):23-8.
  • 12. Hasanin A, Aiyad A, Elsakka A, Kamel A, Fouad R, Osman M et al. Leg elevation decreases the incidence of post-spinal hypotension in cesarean section: a randomized controlled trial. BMC Anesthesiol. 2017;17(1):60.
  • 13. Lee SW, Khaw KS, Ngan Kee WD, Leung TY, Critchley LA. Haemodynamic effects from aortocaval compression at different angles of lateral tilt in non-labouring term pregnant women. Br J Anaesth. 2012;109(6):950-6.
  • 14. Obasuyi BI, Fyneface-Ogan S, Mato CN. A comparison of the haemodynamic effects of lateral and sitting positions during induction of spinal anaesthesia for caesarean section. Int J Obstet Anesth. 2013;22(2):124-8.
  • 15. Reynolds F, Seed PT. Anaesthesia for caesarean section and neonatal acid-base status: a meta-analysis. Anaesthesia. 2005;60(7):636-53.
  • 16. Critchley, LA, Short TG, Gin T. Hypotension during subarachnoid anaesthesia: haemodynamic analysis of three treatments. Br J Anaesth. 1994;72(2):151-5.
There are 16 citations in total.

Details

Primary Language English
Subjects Anaesthesiology
Journal Section Research article
Authors

Feyza Bolcal Çalışır 0000-0002-8882-4666

Aykut Urfalıoğlu 0000-0002-0657-7578

Neşe Yücel This is me 0000-0002-5689-1311

Hafize Öksüz 0000-0001-5963-6861

Gözen Öksüz 0000-0001-5197-8031

Adem Doğaner 0000-0002-0270-9350

Ömer Faruk Boran 0000-0002-0262-9385

Publication Date September 1, 2019
Published in Issue Year 2019 Volume: 3 Issue: 9

Cite

APA Bolcal Çalışır, F., Urfalıoğlu, A., Yücel, N., Öksüz, H., et al. (2019). Impact of leg elevation added to a 15˚ left lateral incline on maternal hypotension and neonatal outcomes in cesarean section: A randomized clinical study. Journal of Surgery and Medicine, 3(9), 689-693. https://doi.org/10.28982/josam.559641
AMA Bolcal Çalışır F, Urfalıoğlu A, Yücel N, Öksüz H, Öksüz G, Doğaner A, Boran ÖF. Impact of leg elevation added to a 15˚ left lateral incline on maternal hypotension and neonatal outcomes in cesarean section: A randomized clinical study. J Surg Med. September 2019;3(9):689-693. doi:10.28982/josam.559641
Chicago Bolcal Çalışır, Feyza, Aykut Urfalıoğlu, Neşe Yücel, Hafize Öksüz, Gözen Öksüz, Adem Doğaner, and Ömer Faruk Boran. “Impact of Leg Elevation Added to a 15˚ Left Lateral Incline on Maternal Hypotension and Neonatal Outcomes in Cesarean Section: A Randomized Clinical Study”. Journal of Surgery and Medicine 3, no. 9 (September 2019): 689-93. https://doi.org/10.28982/josam.559641.
EndNote Bolcal Çalışır F, Urfalıoğlu A, Yücel N, Öksüz H, Öksüz G, Doğaner A, Boran ÖF (September 1, 2019) Impact of leg elevation added to a 15˚ left lateral incline on maternal hypotension and neonatal outcomes in cesarean section: A randomized clinical study. Journal of Surgery and Medicine 3 9 689–693.
IEEE F. Bolcal Çalışır, “Impact of leg elevation added to a 15˚ left lateral incline on maternal hypotension and neonatal outcomes in cesarean section: A randomized clinical study”, J Surg Med, vol. 3, no. 9, pp. 689–693, 2019, doi: 10.28982/josam.559641.
ISNAD Bolcal Çalışır, Feyza et al. “Impact of Leg Elevation Added to a 15˚ Left Lateral Incline on Maternal Hypotension and Neonatal Outcomes in Cesarean Section: A Randomized Clinical Study”. Journal of Surgery and Medicine 3/9 (September 2019), 689-693. https://doi.org/10.28982/josam.559641.
JAMA Bolcal Çalışır F, Urfalıoğlu A, Yücel N, Öksüz H, Öksüz G, Doğaner A, Boran ÖF. Impact of leg elevation added to a 15˚ left lateral incline on maternal hypotension and neonatal outcomes in cesarean section: A randomized clinical study. J Surg Med. 2019;3:689–693.
MLA Bolcal Çalışır, Feyza et al. “Impact of Leg Elevation Added to a 15˚ Left Lateral Incline on Maternal Hypotension and Neonatal Outcomes in Cesarean Section: A Randomized Clinical Study”. Journal of Surgery and Medicine, vol. 3, no. 9, 2019, pp. 689-93, doi:10.28982/josam.559641.
Vancouver Bolcal Çalışır F, Urfalıoğlu A, Yücel N, Öksüz H, Öksüz G, Doğaner A, Boran ÖF. Impact of leg elevation added to a 15˚ left lateral incline on maternal hypotension and neonatal outcomes in cesarean section: A randomized clinical study. J Surg Med. 2019;3(9):689-93.
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