Hajian Pooran, Nikooseresht Mahshid, Lotfi Tayebe
Department of Anesthesiology, School of Medicine, Hamedan University of Medical Sciences, Hamadan, Iran.
School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran.
Anesth Pain Med. 2017 Feb 7;7(2):e43462. doi: 10.5812/aapm.43462. eCollection 2017 Apr.
BACKGROUND: Hypotension is one of the most common complications of spinal anesthesia in parturients undergoing cesarean section. In this regard, the patient's position may affect the incidence of hypotension. OBJECTIVES: In this clinical trial, we evaluated the effects of 1- and 2-minute sitting positions versus immediately lying down after spinal anesthesia on hypotension and vasopressor requirements. METHODS: A total of 72 parturients, scheduled for cesarean section under spinal anesthesia, were randomly divided into 3 groups (24 subjects per group). Groups S1 and S2 remained in a sitting position for 1 and 2 minutes after the induction of spinal anesthesia, respectively, while group T was immediately placed in a lying position. Systolic, diastolic, and mean arterial blood pressure, as well as heart rate, was recorded at 1, 2, 3, and 5 minutes after anesthesia induction, every 5 minutes during the first 30 minutes of surgery, and then every 10 minutes until the end of surgery. P-value less than 0.05 was considered statistically significant. RESULTS: The overall frequency of hypotension was 50 (69%) cases during surgery; the reported frequency was higher in group T in comparison with group S2 (P = 0.003). The frequency of hypotension before delivery (the first 5 minutes after spinal anesthesia) was 40 (55%) cases, with a higher frequency reported in group T (20, 83%), compared to groups S1 (12, 50%) and S2 (8, 33%) (P = 0.03 and P = 0.001, respectively). The ephedrine requirement in group T (11.73 ± 7.16 mg) was higher than the other two groups (8.69 ± 7.57 and 7.82±7.95 mg in groups S1 and S2, respectively); nevertheless, the difference was not statistically significant (P = 0.19). Moreover, the difference in time to achieve T6 sensory level was only significant between group T (3.25 ± 1.1 minutes) and group S2 (4.73 ± 1.73 minutes) (P = 0.03). CONCLUSIONS: The present study showed that 1- or 2-minute sitting position after spinal anesthesia with 2.5 cc of hyperbaric bupivacaine in elective cesarean section results in more hemodynamic stability, compared with immediately lying down.
背景：低血压是剖宫产产妇脊髓麻醉最常见的并发症之一。在这方面，患者的体位可能会影响低血压的发生率。 目的：在这项临床试验中，我们评估了脊髓麻醉后1分钟和2分钟坐位与立即卧位对低血压和血管升压药需求的影响。 方法：总共72例计划在脊髓麻醉下进行剖宫产的产妇被随机分为3组（每组24名受试者）。S1组和S2组在脊髓麻醉诱导后分别保持坐位1分钟和2分钟，而T组立即卧位。在麻醉诱导后1、2、3和5分钟记录收缩压、舒张压和平均动脉压以及心率，在手术的前30分钟内每5分钟记录一次，然后每10分钟记录一次直至手术结束。P值小于0.05被认为具有统计学意义。 结果：手术期间低血压的总发生率为50例（69%）；与S2组相比，T组报告的发生率更高（P = 0.003）。分娩前（脊髓麻醉后前5分钟）低血压的发生率为40例（55%），与S1组（12例，50%）和S2组（8例，33%）相比，T组报告的发生率更高（20例，83%）（分别为P = 0.03和P = 0.001）。T组麻黄碱需求量（11.73±7.16mg）高于其他两组（S1组和S2组分别为8.69±7.57mg和7.82±7.95mg）；然而，差异无统计学意义（P = 0.19）。此外，达到T6感觉平面的时间差异仅在T组（3.25±1.1分钟）和S2组（4.73±1.73分钟）之间具有统计学意义（P = 0.03）。 结论：本研究表明，在择期剖宫产中，脊髓麻醉后采用2.5cc重比重布比卡因，1分钟或2分钟坐位比立即卧位能带来更好的血流动力学稳定性。
Acta Anaesthesiol Scand. 2002-4
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