Cesarean Section Complications Clinical Trial
Official title:
Hemodynamic Effect of Three Randomized Angles of Left Tilting After Spinal Anesthesia for Cesarean Delivery
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
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.
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