Correspondence  |   April 2018
Left Lateral Table Tilt for Elective Cesarean Delivery under Spinal Anesthesia Should Not Be Abandoned
Author Notes
  • Advocate Illinois Masonic Medical Center, Chicago, Illinois (N.N.K). nick.knezevic@gmail.com
  • (Accepted for publication December 21, 2017.)
    (Accepted for publication December 21, 2017.)×
Article Information
Correspondence
Correspondence   |   April 2018
Left Lateral Table Tilt for Elective Cesarean Delivery under Spinal Anesthesia Should Not Be Abandoned
Anesthesiology 4 2018, Vol.128, 860-861. doi:10.1097/ALN.0000000000002095
Anesthesiology 4 2018, Vol.128, 860-861. doi:10.1097/ALN.0000000000002095
We have read with interest an article by Lee et al. published in the August 2017 issue of Anesthesiology.1  We wish to congratulate the authors for evaluating the effects of supine positioning compared with a 15o left uterine displacement tilt on neonatal acid-base status in healthy, nonlaboring, term women scheduled for elective cesarean delivery under spinal anesthesia when systolic blood pressure was maintained using a crystalloid preemptive bolus and a phenylephrine infusion.
The authors found no effect of maternal positioning on neonatal acid-base status and concluded that the supine position was not inferior to the tilted left uterine displacement position. Because the study was conducted on nonlaboring healthy women, however, as stated in its limitations, we suggest that the tilted left uterine displacement position should not be abandoned despite the findings of this study. Even though there were no changes in neonatal acid-base status, the study’s results actually indicate the superiority of a 15o tilted left uterine displacement position as compared with the supine position. Patients who were in the supine position had statistically significant lower systolic blood pressures and cardiac outputs, and required significantly higher mean doses of phenylephrine during the first 15 min after placement of spinal anesthesia to maintain their blood pressure, as compared with the tilted left uterine displacement group. We believe that based on this study the supine position may serve as a safe alternative to the left uterine displacement position in above-mentioned patients only when 15o tilt is not feasible, which realistically should be extremely rare under elective conditions.
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