HEMODYNAMIC EFFECTS OF LATERAL TILT BEFORE AND AFTER SUBARACHNOID BLOCK DURING CAESAREAN DELIVERY.
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Keywords
Supine hypotension syndrome, cesarean delivery, spinal anesthesia, 15-degree lateral tilt, hemodynamic stability, mean arterial pressure, heart rate, aortocaval compression, vasopressor usage, maternal cardiovascular health.
Abstract
Supine hypotension during cesarean delivery under spinal anesthesia is a common clinical challenge caused by aortocaval compression by the gravid uterus, leading to decreased cardiac output and hypotension. The study aims to evaluate the impact of a 15 degree left lateral tilt on hemodynamic variables, including mean arterial pressure (MAP) and heart rate (HR), before and after spinal anesthesia and following fetal delivery, in a resource-limited setting.
Methodology: A prospective observational study was conducted on 55 term pregnant women at Dow University of Health Sciences, Pakistan. Patients were positioned supine and with a 15 degree left lateral tilt. Hemodynamic parameters were measured before and after subarachnoid block using standard monitors. Statistical analysis was performed using paired t-tests and ANOVA, with significance set at p < 0.05.
Results: The 15-degree lateral tilt significantly improved MAP and HR compared to the supine position before and after spinal anesthesia (p < 0.05). The incidence of hypotension, dizziness, pallor, and nausea was markedly lower in the lateral tilt position post-block and post-delivery. Vasopressor usage was reduced to 23.21%.
Conclusion: The 15 degree lateral tilt is an effective, non-pharmacological intervention for mitigating hemodynamic disturbances during cesarean delivery under spinal anesthesia. It enhances maternal cardiovascular stability and reduces adverse symptoms, particularly in resource-constrained settings. Further research is needed to validate these findings in broader populations.
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Hubba Ahmed
FCPS, MBBS Senior Registrar Anesthesiology Dow University of Health Sciences
Muhammad Arsalan Jamil
Obstetric Anesthesia Fellowship, FCPS, MBBS Assistant Professor Anesthesiology Dow University of Health Sciences
Hajra Zafar Siddiqui
FCPS, MBBS, Senior Registrar Anesthesiology Sindh Institute of Urology and Transplantation
Umama Masnoon
FCPS, MBBS Senior Registrar Anesthesiology Dow University of Health Sciences
Muhammad Nauman Aqeel
FCPS, MBBS Senior Registrar Anesthesiology Dr. Ziauddin University Hospital
Shaista Uzair
FCPS, MBBS Senior Registrar Anesthesiology Dow University of Health Sciences