Research Article

Comparative Study of Hemodynamic Changes and the Need for Inotropes in Patients Undergoing Cesarean Section with Spinal Anesthesia in Fowler and Left-Lateral Positions

Abstract

Background: Although spinal anesthesia is a suitable method of choice for cesarean section, there are many complications, including bradycardia and hypotension. Choosing a suitable position is an effective factor in controlling and reducing these complications. Based on this, this study was designed to investigate the hemodynamic status of pregnant patients undergoing cesarean section and spinal anesthesia in two positions, Fowler and left-lateral.
Methods: A total of 62 patients undergoing elective cesarean section surgery were enrolled in this single-center, prospective cohort trial and no blindness study. Patients aged 18-45 years in Shariati Hospital between February 2023 and September 2023 were entered for evaluation and follow-up. After spinal anesthesia, patients' vital signs, including respiratory rate, heart rate, systolic and diastolic blood pressure, mean arterial pressure, and percentage of arterial oxygen saturation, were recorded in minutes 1, 2, 3, 4, 5, 15, 30, 45, and 60.
Results: From the beginning of spinal anesthesia until minute 4, systolic blood pressure in group Fowler dropped more severely than in group Left-lateral, and this difference was significant (P<0.001). The decrease in blood pressure from minute 1 to 4 was much higher in group Fowler than in group Left-lateral, and this difference was significant (P<0.001). Patients in group Left-lateral had a significantly lower respiratory rate than group Fowler (P=0.002). Changes in the percentage of oxygen saturation between the two groups were statistically insignificant. Although the frequency of receiving inotropes in the group of left-lateral patients was lower than in the group of Fowler patients (40% compared to 60%), this correlation was not significant.
Conclusion: Induction of spinal anesthesia in patients in the left-lateral position had lower hemodynamic changes and better stability than the Fowler position.

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Keywords
Cesarean Spinal Anesthesia Hemodynamic Inotrope
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Dabirashrafi B, Atef-Yekta R, Marashi M, Teymourei Khanesari K, Dabirashrafi K, Hashemian M, Khajehnasiri A. Comparative Study of Hemodynamic Changes and the Need for Inotropes in Patients Undergoing Cesarean Section with Spinal Anesthesia in Fowler and Left-Lateral Positions. Arch Anesth & Crit Care. 2026;.