• Hansjoerg Aust, Sigmund Koehler, Maritta Kuehnert, and Thomas Wiesmann.
• Department of Anaesthesiology and Intensive Care, Philipps-University of Marburg UKGM StO. Marburg, Baldingerstrasse D-35033 Marburg, Germany. Electronic address: aust@staff.uni-marburg.de.
• J Clin Anesth. 2016 Aug 1; 32: 47-53.

ObjectiveLeft lateral table tilt of 15° to 30° is recommended for cesarean section, although little is known about the practical problems of its implementation. This study examines these issues from the perspective of anesthesiologists, obstetricians, theater nurses, and patients. Initially, the tilt was set by visual estimation in 100 women and checked by inclinometer afterwards.Study DesignObservational survey.PatientsOne hundred women undergoing primary cesarean section.InterventionThe anesthesiologist's initial estimated tilt setting was documented, then patient comfort and obstetrician's needs were assessed at 15°, and the tilt was adjusted accordingly. Problems were identified, and possible solutions were introduced. The effects of our solutions were reevaluated after 12months.ResultsDespite appropriate training, too little tilt was achieved in most cases. Even with objective inclinometry, complaints by patients, obstetricians, and theater nurses made physicians reluctant to press for 15° tilt. Better compliance was achieved by the introduction of a 2-step tilt procedure, side bar mounting, and inclinometry. After 12months, 96% of anesthesiologists were using the inclinometer to set at least 10°. Most observed an improvement in patient care.ConclusionImplementation of 10° to 15° tilt requires objective inclinometry. It allows tilt adjustment to be made by interdisciplinary staff in greater confidence that patient comfort and surgical conditions will not be impaired. Strategies to reduce discomfort are presented in this article.Copyright © 2016 Elsevier Inc. All rights reserved.

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