Cesarean Section Complications, Spinal Anesthetic Complications
Conditions
Brief summary
The aim of this work is to investigate the effect of different angles of lateral tilt on the maternal hemodynamics before and after subarachnoid block
Detailed description
Aortocaval compression (ACC) by the gravid uterus is a known physiological phenomenon that is classically claimed to cause supine hypotension in full term pregnant women. ACC has been also mentioned as a possible cause of post-spinal hypotension (PSH) in parturients undergoing cesarean section (CS); however, the evidence for the value of left lateral tilting of parturient in improving hemodynamics is not clear. The aim of this work is to investigate the effect of different angles of lateral tilt on the maternal hemodynamics before and after subarachnoid block (SAB). Hemodynamic variables will be taken before SAB in three angles (zero angle, 15 degree angle, and 30 degree angles) of left lateral tilt. Patients will receive normal SAB after prophylactic vasopressor adminstration (either 15 mg ephedrine or 1.5 mcg/Kg phenylephrine intravenous bolus) then hemodynamic variables will measured again after SAB in the same three angles. The sequence of the tilting angles will be randomized. Another measure will be taken after delivery of the fetus. SAB will be done in sitting position under complete asepsis using 25 g spinal needle with crystalloid infusion of 500 mL. SAB will be achieved by intrathecal injection of 10 mg hyperbaric Bupivacaine plus 25ug fentanyl. Success of SAB will be tested within five minutes after drug injection. SAB will be considered successful if adequate block reached T4 dermatome. Cardiac output and stroke volume will be measured using electrical cardiometry device.
Interventions
OTHERleft lateral tilting in 15 degrees
The mother will be placed in left lateral tilted position (15 degrees) using a standard wedge
OTHERleft lateral tilting in 30 degrees
The mother will be placed in left lateral tilted position (30 degrees) using a standard wedge
OTHERsupine position
The mother will be placed in standard supine position
Sponsors
Cairo University
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
PREVENTION
Masking
NONE
Intervention model description
The study will investigate the effect of different tilting angles on the hemodynamics of full term pregnants before and after spinal anesthesia
Eligibility
Sex/Gender
FEMALE
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* full term parturients scheduled for cesarean delivery
Exclusion criteria
* BMI \> 35 Kg/m2, polyhydramnios, history of impaired cardiac contractility, valvular heart disease, cardiac arrhythmias, hypertensive pregnancy disorders
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Cardiac output | 30 minutes after spinal anesthesia in different angles of left lateral tilting | Cardiac output in liters per minute measured by electrical cardiometry |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| cardiac output | before spinal anesthesia in different angles of left lateral tilting | Cardiac output in liters per minute measured by electrical cardiometry |
| mean arterial blood pressure | before spinal anesthesia in different angles of left lateral tilting | mean arterial blood pressure measured by non-invasive monitor |
| stroke volume | before spinal anesthesia in different angles of left lateral tilting | stroke volume in milliliters measured by electrical cardiometry |
| systemic vascular resistance | before spinal anesthesia in different angles of left lateral tilting | measured in mmHg × min / mL by electrical cardiometry |
| heart rate | before spinal anesthesia in different angles of left lateral tilting | measured in beat per minute |
Countries
Egypt
Contacts
Primary ContactAhmed Shash, Professor
Outcome results
None listed