Effect of left tilt 15-degree position on the hemodynamic changes during cesarean section under combined spinal-epidural anesthesia

CHEN Zhi-qiang; LEI Hong-yi; YE Xiao-ping; LIANG Qi-bo; ZHANG Hong-fei; XU Shi-yuan

Abstract：Objective To investigate the effect of left tilt 15-degree position on hemodynamic changes with the non-invasive hemodynamic monitor ( NICOM) during cesarean section under combined spinal -epidural anesthesia. Methods 40 ASAⅠ-Ⅱpuerperas undergoing cesarean section under combined spinal-epidural anesthesia were en-rolled and divided into supine group and left tilt 15-degree group randomly.Hemodynamic parameters including cardiac output, stroke volume, mean arterial pressure, heart rate, total peripheral vascular resistance, and thoracic fluid content were recorded at 6 time points by NICOM system: baseline, 3 min after lateral position, 3 min after spinal anesthesia, skin incision, 3 min after delivery, end of operation.Results No significant difference between two groups were observed in total infusion, usage of vasoactive drugs, heart rate and thoracic fluid content (P>0.05).Cardiac output and stroke volume showed statistically significant differences at various time points within each group ( P<0.05 ) but not between groups(P>0.05).Blood pressure and total peripheral resistance in the supine group were significantly decreased when compared with the left tilt group after anesthesia ( P<0.05 ) .Conclusion There is dramatic hemodynamic fluctuation during cesarean section under combined spinal-epidural anesthesia, which mainly occurs after anesthesia and around de-livery of the baby, and it needs to be monitored real-time and accurately.Assuming a left tilt 15-degree position with proper fluid therapy and anesthesia management can minimize hypotension occurrence.