Hemodynamic Effect of Three Randomized Angles of Left Tilting After Spinal Anesthesia for Cesarean Delivery
试验速览
- 阶段
- 不适用
- 入组人数
- 61
- 试验地点
- 1
- 主要终点
- Cardiac output
研究概览
简要总结
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
详细描述
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.
研究设计
- 研究类型
- Interventional
- 分配方式
- Na
- 干预模型
- Single Group
- 主要目的
- Prevention
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- Female
- 接受健康志愿者
- 否
入选标准
- •full term parturients scheduled for cesarean delivery
排除标准
- •BMI > 35 Kg/m2, polyhydramnios, history of impaired cardiac contractility, valvular heart disease, cardiac arrhythmias, hypertensive pregnancy disorders
研究组 & 干预措施
left lateral tilting arm
all patients will be put in three angles of left lateral tilt in randomized order (supine position - left lateral tilting in 15 degrees - and left lateral tilting in 30 degrees) and the hemodynamic data will be compared in the three angles.
干预措施: left lateral tilting in 15 degrees (Other)
left lateral tilting arm
all patients will be put in three angles of left lateral tilt in randomized order (supine position - left lateral tilting in 15 degrees - and left lateral tilting in 30 degrees) and the hemodynamic data will be compared in the three angles.
干预措施: left lateral tilting in 30 degrees (Other)
left lateral tilting arm
all patients will be put in three angles of left lateral tilt in randomized order (supine position - left lateral tilting in 15 degrees - and left lateral tilting in 30 degrees) and the hemodynamic data will be compared in the three angles.
干预措施: supine position (Other)
结局指标
主要结局
Cardiac output
时间窗: 30 minutes after spinal anesthesia in different angles of left lateral tilting
Cardiac output in liters per minute measured by electrical cardiometry
次要结局
- systemic vascular resistance(30 minutes after spinal anesthesia in different angles of left lateral tilting)
- heart rate(30 minutes after spinal anesthesia in different angles of left lateral tilting)
- stroke volume(30 minutes after spinal anesthesia in different angles of left lateral tilting)
- mean arterial blood pressure(30 minutes after spinal anesthesia in different angles of left lateral tilting)
- cardiac output(before spinal anesthesia in different angles of left lateral tilting)
研究者
Ahmed Hasanin
Lecturer of anesthesia and critical care medicine
Cairo University