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Effect of Right-Lateral Versus Left-Lateral Tilt Position on Compression of the Inferior Vena Cava in Pregnant Women Determined by Magnetic Resonance Imaging

Fujita, Nobuko MD*; Higuchi, Hideyuki MD, PhD; Sakuma, Shiori MD; Takagi, Shunichi MD, PhD; Latif, Mahbub A. H. M. PhD§; Ozaki, Makoto MD, PhD

doi: 10.1213/ANE.0000000000004166
Obstetric Anesthesiology: Original Clinical Research Report
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BACKGROUND: Despite the existing dogma that women undergoing cesarean delivery under spinal anesthesia should be positioned with a 15° left-lateral tilt, the patients were actually positioned in a right-lateral tilt position in several of the original studies. The superiority of right versus left positioning for optimal inferior vena cava volume is unknown. We used magnetic resonance imaging to compare the effects of right-lateral and left-lateral tilt positions on abdominal aortic and inferior vena cava volumes in pregnant women.

METHODS: Thirteen women with singleton pregnancies and gestational age 31–39 weeks underwent magnetic resonance imaging while in the supine position, and in the left-lateral (15° and 30°) and right-lateral tilt (15° and 30°) positions, which were maintained by placing a 1.5-m–long piece of polyethylene foam under either side of the body. Abdominal aorta and inferior vena cava volume were measured between the L1–L2 disk and L3–L4 disk levels using magnetic resonance images.

RESULTS: Aortic volume did not differ significantly among any of the positions examined. Mean inferior vena cava volume was significantly greater in the 30° left-lateral tilt position than in the 15° right-lateral tilt (10.7 ± 7.5 vs 5.9 ± 5.1 mL; mean difference, 4.8; 95% CI, 1.2–8.5; P = .002) and 30° right-lateral tilt (10.7 ± 7.5 vs 5.9 ± 2.5 mL; mean difference, 4.8; 95% CI, 1.2–8.4; P = .002) positions. Mean inferior vena cava volume in the 15° left-lateral tilt position did not differ significantly from that in the 15° right-lateral tilt (mean difference, 0.4; 95% CI, −3.2 to 4.0; P = 1.000) or 30° right-lateral tilt (mean difference, 0.4; 95% CI, −3.3 to 4.0; P = 1.000) positions. Mean inferior vena cava volume in the supine position only differed significantly from that in the 30° left-lateral tilt position (5.2 ± 3.8 vs 10.7 ± 7.5 mL; mean difference, 5.5; 95% CI, 1.8–9.1; P < .001). The greatest inferior vena cava volume was observed in the 30° left-lateral tilt position in 9 of 13 subjects (70%), and in the 30° right-lateral tilt in 3 subjects (23%).

CONCLUSIONS: The 30° left-lateral tilt position most consistently reduced inferior vena cava compression by the gravid uterus compared with the supine position. Mean inferior vena cava volume in pregnant women was not increased at either angle of the right-lateral tilt position compared with the 30° left-lateral tilt position. However, in a subset of patients, the 30° right-lateral tilt position achieved the optimal inferior vena cava volume. Further investigation to understand this variability is warranted.

From the *Department of Anesthesia, St Luke’s International Hospital, Tokyo, Japan

Department of Anesthesiology, Tokyo Women’s Medical University, Tokyo, Japan

Department of Anesthesiology, Nihon University School of Medicine, Tokyo, Japan

§Graduate School of Public Health, St Luke’s International University, Tokyo, Japan.

Published ahead of print 28 February 2019.

Accepted for publication February 28, 2019.

Funding: Institutional/departmental.

The authors declare no conflicts of interest.

This report was presented at the Euroanaesthesia 2017 European Anaesthesiology Congress, Geneva, Switzerland, June 3–5, 2017.

Clinical Trial Number and Registry URL: This study was registered at the University Hospital Medical Information Network clinical trial registration (No. UMIN000031273).

Reprints will not be available from the authors.

Address correspondence to Nobuko Fujita, MD, Department of Anesthesia, St Luke’s International Hospital, 9-1 Akashicho, Chu-o-ku, Tokyo 104–8560, Japan. Address e-mail to nobukofu@luke.ac.jp.

Copyright © 2019 International Anesthesia Research Society
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