• Can J Anaesth · Oct 2021

    Observational Study

    Ultrasound evaluation of inferior vena cava compression in tilted and supine term parturients.

    • Marie-Pierre Gagné, Philippe Richebé, Christian Loubert, Pierre Drolet, Quentin Gobert, André Denault, and Valerie Zaphiratos.
    • Department of Anesthesiology and Pain Medicine, Maisonneuve-Rosemont Hospital, CIUSSS de l'Est de l'Ile de Montreal (CEMTL), University of Montreal, 5415 boul. de l'Assomption, Montreal, QC, H1T 2M4, Canada.
    • Can J Anaesth. 2021 Oct 1; 68 (10): 1507-1513.

    PurposeHypotension is common following spinal anesthesia (SA) during elective Cesarean delivery (CD). Although common practice is to alleviate inferior vena cava (IVC) compression, limited evidence supports a 15° tilt for CD. We measured collapsibility of the IVC in supine and 15° left lateral tilt positions with ultrasound before and after SA and phenylephrine infusion in term parturients.MethodsTwenty term parturients scheduled for CD were recruited for this prospective study. Ultrasound measurements of the IVC were taken 1) supine before SA, 2) tilted 15° before SA, 3) supine after SA, and 4) tilted 15° after SA. A phenylephrine infusion was begun after injection of SA. The primary outcome was to evaluate the impact of position on the IVC collapsibility index (IVCCI): a measure of the difference between the maximum and minimum IVC diameter with respiration.ResultsThe mean (standard deviation) IVCCI (%) before SA was higher in the supine 19.5 (8.0) than in the tilted 15.0 (6.4) position (mean difference, 4.5; 95% confidence interval [CI], 0.1 to 8.9; P = 0.04). After SA, there was no significant difference between IVCCI (%) in the supine 17.8 (8.3) and tilted 14.2 (6.9) position (mean difference, 3.5; 95% CI, -0.9 to 7.9; P = 0.13). There was no correlation between the pre-spinal IVVCI measurements and the quantity of phenylephrine used during the surgery.ConclusionThe IVCCI was lower in the 15° tilt position than in the supine position, but not after SA with a phenylephrine infusion. Ultrasound imaging can help identify IVC compression.Trial Registrationwww.clinicaltrials.gov (NCT03410199); registered 18 January 2018.© 2021. Crown.

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