CSEN Survey : Sitting or Lateral Position

On 14.2.98 we sent 1,000 emails to anesthesiologists in 65 countries. 110 emails returned as undeliverable.

The question that we asked was:

What is your preferred way of doing the spinal/epidural anesthesia : Sitting position or lateral position ?

207 anesthesiologists returned their responses (23.2% response rate).

- 111 anesthesiologists (54%) prefer the sitting position.

- 96 anesthesiologists (46%) prefer the lateral position.

Enclosed some of the comments:

Subject:
Re: CSEN Survey: Sitting or Lateral Posi
Date:
Sun, 15 Feb 1998 15:46:55 -0500
From:
Viktor Weisshaeupl <106176.3404@compuserve.com>
To:
Blind.Copy.Receiver@compuserve.com




<< ==========
mail/messages #2953, from Joseph_Eldor, 1469 chars, Sat, 14 Feb 1998 23:36:06
>What is your preferred way of doing the spinal/epidural anesthesia:
>Sitting position or Lateral position?
>Please answer by: Sitting or Lateral.

Lateral primarily, except in

- very obese patients,

- C-section in this hospital, where the OR-table does not permit
lateral position since they position the patient in Lloyd-Davis
position. I would do them and have done them in lateral, before
I came to this place.

- There seems to be a cultural difference in the choice of lateral/
vs sitting. I did my training in Finland, where all the people
use the lateral position, I started out as a student learning
lateral position. Here in Austria practically nobody does lateral
and all have the patients sitting.

Viktor Weisshaeupl, Vienna, Austria - Europe
106176.3404@compuserve.com




Subject:
Re: CSEN Survey: Sitting or Lateral Position in Spinal/Epidural
Anesthesia
Date:
Mon, 16 Feb 1998 08:28:30 +1100
From:
Chris Thompson
To:
Joseph Eldor <a1b2c3d4@netvision.net.il>


>Dear Colleague,
>
>This email is sent to 1,000 anesthesiologists in 65 countries.
>We thank you in advance for participating in this new CSEN Survey.
>Please answer the following qustion:
>
>What is your preferred way of doing the spinal/epidural anesthesia:
>Sitting position or Lateral position?
>Please answer by: Sitting or Lateral.

lateral, midline for epidural
lateral, paramedian for spinal


Chris


------------------------------------------------------------------
Chris Thompson http://www.ozemail.com.au/~clt1/
Department of Anaesthesia
Royal Prince Alfred Hospital voice +61 2 515 8564
Camperdown Sydney Australia 2050 fax +61 2 519 2455

Virtual Anaesthesia Textbook:
http://www.usyd.edu.au/su/anaes/VAT/VAT.html

Australasian Anaesthesia:
http://www.usyd.edu.au/su/anaes/anaes.html
-------------------------------------------------------------------



Subject:
Re: CSEN Survey: Sitting or Lateral Position in Spinal/Epidural
Date:
Mon, 16 Feb 1998 07:52:33 UTC-2
From:
"James, MFM , Mike, Prof" <james@samiot.uct.ac.za>
To:
Joseph Eldor <a1b2c3d4@netvision.net.il>


Equally confortable with either sitting or lying - patient factors
and comfort make my decision.
MFM James MBChB FRCA PhD
Professor & Head
Department of Anaesthesia
University of Cape Town
Cape Town, South AFrica
Tel: (021) 406-6143
Fax: (021) 47-5206


Subject:
Ang: CSEN Survey: Sitting or Lateral Position in Spinal/Epidural
Anesthesia
Date:
Mon, 16 Feb 1998 8:08:10 +0100
From:
mirek.sznurowski@ltvastmanland.se
To:
a1b2c3d4@netvision.net.il


..both!!!

It depands on a patient, his anatomy, desired spread, etc.

MS






MIME:a1b2c3d4 @ netvision.net.il den 98-02-14 22.30.39
Till: Mirek Sznurowski
Kopia:
?rende: CSEN Survey: Sitting or Lateral Position in Spinal/Epidural Anesthesia

Dear Colleague,

This email is sent to 1,000 anesthesiologists in 65 countries.
We thank you in advance for participating in this new CSEN Survey.
Please answer the following qustion:

What is your preferred way of doing the spinal/epidural anesthesia:
Sitting position or Lateral position?
Please answer by: Sitting or Lateral.

This question doesn`t refer to the position of the anesthesiologist
while doing the procedure...

Sincerely yours,

Joseph Eldor, MD
Editor, CSEN - The Global Regional Anesthesia Website
http://www.csen.com/anesthesia



Subject:
Re: CSEN Survey: Sitting or Lateral Position in
Spinal/Epidural Anesthesia
Date:
Sun, 15 Feb 1998 19:04:32 +0000
From:
"j.zwijsen" <jzwijsen@worldonline.nl>
To:
Joseph Eldor <a1b2c3d4@netvision.net.il>
References:
1


Hello,
My favourite position is the sitting because of the symmetric anatomy!
Greetings,
J. Zwijsen, Alkmaar the Netherlands


Subject:
CSEN Survey: Sitting or Lateral Position in Spinal
Date:
15 Feb 1998 08:00:34 EDT
From:
Delfino@digi.com.br
To:
a1b2c3d4@netvision.net.il


A1>Dear Colleague,

A1>This email is sent to 1,000 anesthesiologists in 65 countries.
A1>We thank you in advance for participating in this new CSEN Survey.
A1>Please answer the following qustion:

A1>What is your preferred way of doing the spinal/epidural anesthesia:
A1>Sitting position or Lateral position?
A1>Please answer by: Sitting or Lateral.

A1>This question doesn`t refer to the position of the anesthesiologist
A1>while doing the procedure...

A1>Sincerely yours,

A1>Joseph Eldor, MD
A1>Editor, CSEN - The Global Regional Anesthesia Website
A1>http://www.csen.com/anesthesia

Dear Joseph

I always perform spinal blocks having the patient in the sitting
position. It makes no difference which position is selected, but using
spinal isobaric bupivacaine immediately after the block is done the patient is
kept in decubitus to avoid the cephalic spread of the drug.I have paper
published on the subject. If necessary, I can give you the reference.

Sincerely,

Delfino


Subject:
SV: CSEN Survey: Sitting or Lateral Position in Spinal/Epidural
Anesthesia
Date:
Sun, 15 Feb 1998 11:01:36 +0100
From:
Peter Anthony Berlac <Peter.Berlac@dadlnet.dk>
To:
"'Joseph Eldor'" <a1b2c3d4@netvision.net.il>



----------
Fra: Joseph Eldor[SMTP:a1b2c3d4@netvision.net.il]
Sendt: 14. februar 1998 22.58
Til: Peter.Berlac@dadlnet.dk;
Emne: CSEN Survey: Sitting or Lateral Position in Spinal/Epidural Anesthesia

Dear Colleague,

This email is sent to 1,000 anesthesiologists in 65 countries.
We thank you in advance for participating in this new CSEN Survey.
Please answer the following qustion:

What is your preferred way of doing the spinal/epidural anesthesia:
Sitting position or Lateral position?
Please answer by: Sitting or Lateral.

This question doesn`t refer to the position of the anesthesiologist
while doing the procedure...

Sincerely yours,

Joseph Eldor, MD
Editor, CSEN - The Global Regional Anesthesia Website
http://www.csen.com/anesthesia


LATERAL for several reasons:
The patient is often premedicated and fasting; sitting position may induce malaise/dizziness
In the lateral position, assisting staff (nurse, nurses assistent, orderly ) may help by "bending" the patient further. This is especially handy for high thoracic epidurals.
Less risk of induced hypotension with fast onset spinals if patient is lying down.
The greatest advantage is of course the possibility of "lateralising" a spinal for hip/knee surgery, anesthetising only the required limb with a relatively small amount of hyperdense local anesthetic, by letting the patient lie with the "sick side down" for 10-15 minutes. Gives better hemodynamic control and ensures that the desired limb is blocked.

Yours,

Peter Anthony Berlac, M.D.
Copenhagen University
Glostrup County Hospital
Dept. of Anaesthesia
2600 Glostrup
Denmark


Subject:
About the setting preferred
Date:
Fri, 27 Feb 1998 16:29:02 -0000
From:
"jose mario martinez marin" <medisys@qro1.telmex.net.mx>
To:
<a1b2c3d4@netvision.net.il>


Dear professor
My sitting is LATERAL, because my obstetric ang ginecologic patients demand
it.
I will thank you our distribution center of peridural /spinal equipment in
Mexico.
Its pleasing your comunication.
j. mario
mart?nez

medisys@qro1.telmex.net.mx


Subject:
Re: CSEN Survey: Sitting or Lateral Position in Spinal/Epidural
Anesthesia
Date:
Thu, 19 Feb 1998 23:15:04 -0000
From:
"Mario Brito" <mb125@mail.telepac.pt>
To:
"Joseph Eldor" <a1b2c3d4@netvision.net.il>



----------
> De: Joseph Eldor <a1b2c3d4@netvision.net.il>
> Para: mb125@mail.telepac.pt;
> Assunto: CSEN Survey: Sitting or Lateral Position in Spinal/Epidural
Anesthesia
> Data: S?bado, 14 de Fevereiro de 1998 20:21
>
> Dear Colleague,
>
> This email is sent to 1,000 anesthesiologists in 65 countries.
> We thank you in advance for participating in this new CSEN Survey.
> Please answer the following qustion:
>
> What is your preferred way of doing the spinal/epidural anesthesia:
> Sitting position or Lateral position?
> Please answer by: Sitting or Lateral.
>
> This question doesn`t refer to the position of the anesthesiologist
> while doing the procedure...
>
> Sincerely yours,
>
> Joseph Eldor, MD
> Editor, CSEN - The Global Regional Anesthesia Website
> http://www.csen.com/anesthesia

-----------------------------------------

Dear Colleague,
I prefer the sitting position for the patient (!!!). I have tried once with
myself laid down, but I couldn't anchieve it. :))))))

Sincerely yours,

Mario Brito, MD


Subject:
Re: CSEN Survey: Sitting or Lateral Position in Spinal/Epidural
Anesthesia
Date:
Thu, 19 Feb 1998 15:32:32 +0200 (IST)
From:
"Dr. Dan Eimerl,M.D." <eimerl@cc.huji.ac.il>
To:
Joseph Eldor <a1b2c3d4@netvision.net.il>


Hi Yossi,
I use mostly,Hyperbaric solution for intrathecal anesthesia.
As a result of that ,my preffered pt's position is according to the
surgical procedure. E.G. lateral for unilateral hernia repair,
sitting for cesarian section,or prostatectomy and so on and so forth.
Best wishes,
Dani Eimerl.


Subject:
Re: CSEN Survey: Sitting or Lateral Position in Spinal/Epidural
Date:
Mon, 16 Feb 1998 11:49:31 +0000
From:
"Alan Aitkenhead" <Alan.Aitkenhead@nottingham.ac.uk>
To:
Joseph Eldor <a1b2c3d4@netvision.net.il>


Date: Sat, 14 Feb 1998 22:13:39 +0200 (IST)
From: Joseph Eldor <a1b2c3d4@netvision.net.il>
To: Alan.Aitkenhead@nottingham.ac.uk;
Subject: CSEN Survey: Sitting or Lateral Position in Spinal/Epidural Anesthesia

Dear Colleague,

This email is sent to 1,000 anesthesiologists in 65 countries.
We thank you in advance for participating in this new CSEN Survey.
Please answer the following qustion:

What is your preferred way of doing the spinal/epidural anesthesia:
Sitting position or Lateral position?
Please answer by: Sitting or Lateral.

This question doesn`t refer to the position of the anesthesiologist
while doing the procedure...

Sincerely yours,

Joseph Eldor, MD
Editor, CSEN - The Global Regional Anesthesia Website
http://www.csen.com/anesthesia

Reply:

It depends on the circumstances: build of patient, ability to
co-operate, height of block required.
Alan Aitkenhead
University Department of Anaesthesia
Queen's Medical Centre
Nottingham NG7 2UH
Telephone +44 (0)115 970 9231
Fax +44 (0)115 970 0739


Subject:
Re: CSEN Survey: Sitting or Lateral Position in Sp
Date:
16 Feb 1998 17:11:36 EDT
From:
Delfino@digi.com.br
To:
a1b2c3d4@netvision.net.il


A1>Delfino@digi.com.br wrote:
A1>>
A1>> A1>Dear Colleague,
A1>>
A1>> A1>This email is sent to 1,000 anesthesiologists in 65 countries.
A1>> A1>We thank you in advance for participating in this new CSEN Survey.
A1>> A1>Please answer the following qustion:
A1>>
A1>> A1>What is your preferred way of doing the spinal/epidural anesthesia:
A1>> A1>Sitting position or Lateral position?
A1>> A1>Please answer by: Sitting or Lateral.
A1>>
A1>> A1>This question doesn`t refer to the position of the anesthesiologist
A1>> A1>while doing the procedure...
A1>>
A1>> A1>Sincerely yours,
A1>>
A1>> A1>Joseph Eldor, MD
A1>> A1>Editor, CSEN - The Global Regional Anesthesia Website
A1>> A1>http://www.csen.com/anesthesia
A1>>
A1>> Dear Joseph
A1>>
A1>> I always perform spinal blocks having the patient in the sitting
A1>> position. It makes no difference which position is selected, but using
A1>> spinal isobaric bupivacaine immediately after the block is done the patien
A1>> kept in decubitus to avoid the cephalic spread of the drug.I have paper
A1>> published on the subject. If necessary, I can give you the reference.
A1>>
A1>> Sincerely,
A1>>
A1>> Delfino

A1>Dear Dr. Delfino,
A1>I would like your pemission to use your letter with your name in the
A1>summary of the data I am collecting now. I would like to get your
A1>reference.
A1>Sincerely yours,
A1>J. Eldor

Dear Joseph

Permission granted. Receive a copy of the abstract from the Revista Brasileira
de
Anestesiologia CD ROM. Please let me know of any problem. I would be
pleased to assist you.

Yours,

Delfino


Anestesia Subaracn?idea com Bupivaca?na a 0,5% Isob?rica.
Influ?ncia da Postura Imediata ? Pun??o na Extens?o e
Qualidade do Bloqueio*
Jos? Delfino da Silva Neto 1 , Nilton Bezerra do Vale 2 , Esa? de Magalh?es 3 ,
Wanuzia Nascimento 4 , Fabrizia Pereira 4
Silva Neto JD, Vale NB, Magalh?es E, Nascimento W, Pereira F - Spinal
Anesthesia with 0.5% Isobaric
Bupivacaine. Influence of Posture Immediately after the Spinal Block on the
Spread and Quality of
Anesthesia
Background and objectives - Changes in posture immediately after spinal
puncture and injection of 0.5%
bupivacaine without glucose modify the cephalic spread of the anesthetic. The
aims of this study were to observe
the onset, the duration and cephalic spread of spinal anesthesia with 0.5%
bupivacaine as a function of the period
the patient remained sitting following the injection.
Methods - Sixty-one patients physical status ASA I or II whose ages ranged from
17 to 82 years old participated
in the study in which they were submitted to spinal anesthesia at L3 - L4
interspace using bupivacaine 0.5% without
glucose in the fixed dose of 15 mg. The patients were allocated into five
groups (GT0, GT1, GT2, GT3, and GT4)
with respect to the period (zero to four minutes) they were kept sitting after
the injection. The following parameters
were observed: a) latency of analgesia; b) duration of the effect; c) level of
the cephalic spread of analgesia; d)
requirement of autonomic disorder treatment.
Results - A shorter latency period was observed in the patients who immediately
returned to the supine position
(108.1 s) compared to the group which remained sitting for a longer period (GT4
= 187.5 s). Cephalic spread was
higher in group GT4 (T3 level) in which there was more need to corretion of the
autonomic disorders.
Conclusion - The time the patients were kept sitting after spinal anesthesia
using 0.5% bupivacaine without
glucose was directly related to a higher level of block and with its consequent
cardiovascular complications.

Rev Bras Anestesiol
1995; 45: 5: 309 - 314


Subject:
CSEN Survey: Sitting or Lateral Position in Spinal/Epidural
Anesthesia
Date:
Mon, 16 Feb 1998 15:20:29 -0500
From:
Eric Weber <e_weber@compuserve.com>
To:
Joseph Eldor <a1b2c3d4@netvision.net.il>


Spinal: Sitting
Epidural Lumbal: Lateral
Thoracic: Sitting
Cervical; Sitting


Subject:
Re: CSEN Survey: Sitting or Lateral Position in Spinal/Epidural
Anesthesia
Date:
Thu, 19 Feb 1998 15:46:30 EST
From:
Elkinsdave@aol.com
To:
a1b2c3d4@netvision.net.il


Dear Dr. Eldor,

Thank you for your questions.

>>What is your preferred way of doing the spinal/epidural anesthesia: Sitting
position or Lateral position?

I usually prefer the patient to be in the sitting position, except in cases in
which a unilateral block is preferable (for example, inguinal herniorrhaphy,
knee arthroscopy, total hip or knee arthroplasty).

Good luck in your research! Sincerely,

Dave Elkins, M.D.
San Diego, CA


Joseph Eldor, MD

Editor, CSEN - The Global Regional Anesthesia Website