Echocardiographic determination of resting haemodynamics and optimal positioning in term pregnant women

Anaesthesia
Alicia T DennisL Leeton

Abstract

Optimal positioning for anaesthesia in pregnant women involves balancing the need for ideal tracheal intubation conditions (achieved by the head elevated ramped position), with the prevention of reduced cardiac output from aortocaval compression (achieved by left lateral pelvic tilt). No studies have examined the effect on cardiac output of left lateral pelvic tilt in the ramped position. We studied non-labouring, non-anaesthetised healthy term pregnant women who underwent baseline (left lateral decubitus) cardiac assessment using transthoracic echocardiography. We then compared cardiac output, maternal physiological variables, fetal heart rate and comfort scores in three positions: left lateral decubitus; ramped position with wedge; and ramped position alone. Thirty women completed the study. Mean (SD) age, gestation and body mass index were 33.5 (3.93) years, 38.5 (0.94) weeks and 29.0 (4.0) kg.m-2 , respectively. Mean ejection fraction, left ventricular internal diameter and mitral valve E/e' were 55.2 (6.8) %, 4.70 (0.43) cm and 7.50 (1.82), respectively. There were no differences in cardiac output between the positions (p = 0.503). There were no differences in systolic (p = 0.955) or diastolic (p = 0.987) blood pressure, m...Continue Reading

References

Jun 16, 2006·International Journal of Obstetric Anesthesia·A PostaciB Dikmen
Feb 15, 2011·International Journal of Obstetric Anesthesia·A T Dennis
Mar 19, 2014·International Journal of Obstetric Anesthesia·K CheesmanJ Douglas
Nov 26, 2015·International Journal of Obstetric Anesthesia·K SaravanakumarP Danielian
Aug 2, 2017·Anesthesia and Analgesia·Allison J Lee, Ruth Landau

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Citations

Aug 30, 2021·Lancet·Jasmeet SoarMichael J A Parr
Jul 8, 2021·European Journal of Anaesthesiology·Christina MassothManuel Wenk

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