Comparison between 60- and 90-seconds Sitting versus Immediate Supine Positioning on Haemodynamic and Ephedrine Use in Spinal Anaesthesia for Lower Abdominal Procedures

Abstract

Background: The period between spinal anaesthesia (SA) induction and supine positioning can influence haemodynamic profile; however, the optimal interval is not known.

Objective: To evaluate the effects of immediate supine positioning (ISP) versus 60-, and 90-secs sitting, on heamodynamic profile.

Methods: Eighty women, 18 – 65 years, with American Society of Anesthesiologists (ASA) status I – III, undergoing lower abdominal surgeries (LAS) were randomised. After SA induction, group A had ISP, while groups B and, C had 60-secs and 90-secs sitting, respectively. The mean intraoperative pulse rate (PR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and rescue ephedrine and intravenous fluid use were compared.

Results: Demographics i.e., mean age, sex, and ASA status were comparable, p-values ˃ 0.05. The mean rescue ephedrine use was 10.22 ± 2.75mg in group A, which is statistically higher than 4.12 ± 1.12mg in B and, 3.46 ± 1.24mg in C, p= value 0.001. The mean SBP was lower at 0, 5, 10, and 15-mins in group A versus B and C, p-value 0.041, 0.015, 0.032, and 0.047 respectively. The mean DBP and MAP values were lower in group A versus B and C, and IV fluid use was increased in group A versus B and C, p-value ˂ 0.05.

Conclusion: There was a decreased SBP, DBP and MAP values and increased rescue ephedrine and fluid use in immediate supine positioning group versus 60- and 90-secs sitting, following SA for LAS, while 90-secs produced the least changes, enhancing safety, and efficacy.