제왕절개술에서 척추마취 후 10분 동안 유지한 측와위가 저혈압 발생과 감각차단에 미치는 영향 (Effect of prolonged lateral position for 10-minutes following spinal anesthesia on hypotension and sensory blockade during cesarean delivery)

서지정보

· 발행기관 : 대한마취통증의학회
· 수록지 정보 : Anesthesia and Pain Medicine / 11권 / 4호 / 354 ~ 358페이지
· 저자명 : 손혜민, 원동욱, 오아영, 황정원, 송인애

초록

Background: During cesarean delivery, hypotension is a frequently occurring adverse effect following spinal anesthesia. Our hypothesis was that hypotension could be avoided or delayed with a lateral decubitus position for 10 minutes after intrathecal injection, by reducing the detrimental effects of the aortocaval compression.
Methods: Spinal anesthesia was performed in the lateral decubitus position with 8 mg of 0.5% hyperbaric bupivacaine and 15 g of fentanyl. Forty-one patients undergoing elective cesarean delivery were randomly assigned to one of two groups. In the experimental group, patients were maintained in the lateral position for 10 minutes following intrathecal injection (group Decubitus). In the control group, patients were repositioned to supine immediately after the injection (group Supine). Incidence of hypotension, the required dose of ephedrine, and characteristics of the sensory blockade, were subsequently investigated.
Results: The incidence of hypotension, the incidence of nausea, and total amount of ephedrine, were not statistically different between the two groups. In group Decubitus, the onset of hypotension was delayed significantly (5.6 ± 1.7 min vs. 13.8 ± 1.7 min, P ＜ 0.001), and the maximal blockade level was more cephalad (T3 [T1–T4] vs. T4 [T3–T5], P ＜ 0.001) when compared to that of group Supine. Apgar scores were comparable in both groups.
Conclusions: Maintaining the lateral position for 10 min following intrathecal injection during cesarean delivery did not influence the incidence of maternal hypotension. However, it caused delayed onset of hypotension and higher cephalad spread of sensory block.

영어초록

Background: During cesarean delivery, hypotension is a frequently occurring adverse effect following spinal anesthesia. Our hypothesis was that hypotension could be avoided or delayed with a lateral decubitus position for 10 minutes after intrathecal injection, by reducing the detrimental effects of the aortocaval compression.
Methods: Spinal anesthesia was performed in the lateral decubitus position with 8 mg of 0.5% hyperbaric bupivacaine and 15 g of fentanyl. Forty-one patients undergoing elective cesarean delivery were randomly assigned to one of two groups. In the experimental group, patients were maintained in the lateral position for 10 minutes following intrathecal injection (group Decubitus). In the control group, patients were repositioned to supine immediately after the injection (group Supine). Incidence of hypotension, the required dose of ephedrine, and characteristics of the sensory blockade, were subsequently investigated.
Results: The incidence of hypotension, the incidence of nausea, and total amount of ephedrine, were not statistically different between the two groups. In group Decubitus, the onset of hypotension was delayed significantly (5.6 ± 1.7 min vs. 13.8 ± 1.7 min, P ＜ 0.001), and the maximal blockade level was more cephalad (T3 [T1–T4] vs. T4 [T3–T5], P ＜ 0.001) when compared to that of group Supine. Apgar scores were comparable in both groups.
Conclusions: Maintaining the lateral position for 10 min following intrathecal injection during cesarean delivery did not influence the incidence of maternal hypotension. However, it caused delayed onset of hypotension and higher cephalad spread of sensory block.

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