• Rachel Hignett, Roshan Fernando, Alan McGlennan, Sarah McDonald, Adrienne Stewart, Malachy Columb, Tina Adamou, and Paul Dilworth.
• Department of Anesthesia, Royal Infirmary of Edinburgh, Edinburgh, UK.
• Anesth. Analg.. 2011 Nov 1;113(5):1098-102.

BackgroundAirway management continues to pose challenges to the obstetric anesthesiologist. Functional residual capacity (FRC), which acts as an oxygen reservoir, is reduced from the second trimester onwards and is exacerbated in the supine position. Mechanisms to increase FRC may delay the onset of hypoxemia during periods of apnea. Values for changes in FRC in term parturients in semierect positions are unknown. We hypothesized that the FRC of healthy term parturients would increase significantly in the 30° head-up position in comparison with the supine position.MethodsTwenty-two healthy term parturients were recruited. Initial screening spirometry was performed to exclude undiagnosed respiratory disease. FRC was measured using the helium dilution technique in the supine, 30° head-up, and sitting erect positions. Subjects were randomized to sequence of position testing order. Noninvasive systolic blood pressure, heart rate, and oxygen saturation were measured twice in each testing position.ResultsResults from 20 subjects were analyzed. The spirometry results for all subjects were within predicted normal reference intervals. FRC measurements differed significantly (P<0.001) among all positions. FRC increased by a mean of 188 mL (95% confidence interval 18 to 358 mL) from the supine to the 30° head-up position (P=0.03). There were no significant differences in vital signs among testing positions (P>0.16).ConclusionsWe have demonstrated that the FRC of healthy term parturients increases significantly in the 30° head-up position in comparison with supine.

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