Newly Published
Perioperative Medicine  |   June 2017
Left Lateral Table Tilt for Elective Cesarean Delivery under Spinal Anesthesia Has No Effect on Neonatal Acid–Base Status: A Randomized Controlled Trial
Author Notes
  • From the Division of Obstetric Anesthesia, Department of Anesthesia, Columbia University, New York, New York (A.J.L., R.L., B.C., S.R.G., R.M.S.); Department of Anesthesia, New York-Presbyterian/Columbia University Medical Center, New York, New York (J.L.M., M.M.M.); and Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York (S.W.).
  • Submitted for publication November 15, 2016. Accepted for publication May 3, 2017.
    Submitted for publication November 15, 2016. Accepted for publication May 3, 2017.×
  • Acknowledgments: We acknowledge Cheetah Medical Inc., Vancouver, Washington, for providing NICOM monitors and disposable sensors for this investigation.
    Acknowledgments: We acknowledge Cheetah Medical Inc., Vancouver, Washington, for providing NICOM monitors and disposable sensors for this investigation.×
  • Research Support: Support was provided solely from institutional and/or departmental sources.
    Research Support: Support was provided solely from institutional and/or departmental sources.×
  • Competing Interests: The authors declare no competing interests.
    Competing Interests: The authors declare no competing interests.×
  • Reproducible Science: Full protocol available at: al3196@cumc.columbia.edu. Raw data available at: al3196@cumc.columbia.edu.
    Reproducible Science: Full protocol available at: al3196@cumc.columbia.edu. Raw data available at: al3196@cumc.columbia.edu.×
  • Correspondence: Address correspondence to Dr. Lee: Columbia University, 622 West 168th Street, PH-5, New York, New York 10032. al3196@cumc.columbia.edu. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Obstetric Anesthesia / Pediatric Anesthesia / Regional Anesthesia
Perioperative Medicine   |   June 2017
Left Lateral Table Tilt for Elective Cesarean Delivery under Spinal Anesthesia Has No Effect on Neonatal Acid–Base Status: A Randomized Controlled Trial
Anesthesiology Newly Published on June 15, 2017. doi:10.1097/ALN.0000000000001737
Anesthesiology Newly Published on June 15, 2017. doi:10.1097/ALN.0000000000001737
Abstract

Background: Current recommendations for women undergoing cesarean delivery include 15° left tilt for uterine displacement to prevent aortocaval compression, although this degree of tilt is practically never achieved. We hypothesized that under contemporary clinical practice, including a crystalloid coload and phenylephrine infusion targeted at maintaining baseline systolic blood pressure, there would be no effect of maternal position on neonatal acid base status in women undergoing elective cesarean delivery with spinal anesthesia.

Methods: Healthy women undergoing elective cesarean delivery were randomized (nonblinded) to supine horizontal (supine, n = 50) or 15° left tilt of the surgical table (tilt, n = 50) after spinal anesthesia (hyperbaric bupivacaine 12 mg, fentanyl 15 μg, preservative-free morphine 150 μg). Lactated Ringer’s 10 ml/kg and a phenylephrine infusion titrated to 100% baseline systolic blood pressure were initiated with intrathecal injection. The primary outcome was umbilical artery base excess.

Results: There were no differences in umbilical artery base excess or pH between groups. The mean umbilical artery base excess (± SD) was −0.5 mM (± 1.6) in the supine group (n = 50) versus −0.6 mM (± 1.5) in the tilt group (n = 47) (P = 0.64). During 15 min after spinal anesthesia, mean phenylephrine requirement was greater (P = 0.002), and mean cardiac output was lower (P = 0.014) in the supine group.

Conclusions: Maternal supine position during elective cesarean delivery with spinal anesthesia in healthy term women does not impair neonatal acid–base status compared to 15° left tilt, when maternal systolic blood pressure is maintained with a coload and phenylephrine infusion. These findings may not be generalized to emergency situations or nonreassuring fetal status.