[Estimating the angle of left lateral decubitus position during cesarean section: observational study of anesthesiologists' estimates and of midwives and nurses' level of understanding]

Abstract

Objectives: To determine the difference between the estimated and measured values of the left lateral decubitus (LLD) angle in the positioning of patients for scheduled cesarean section; to determine whether the accuracy of estimates differs between staff anesthesiologists and residents; and to assess the angle estimates of midwives and surgical nurses as well as their level of knowledge with respect to the utility of the LLD position.

Methods: This was a prospective, observational, double-blind study comparing staff anesthesiologists working in obstetrics to residents in their second, third, or fourth-year of training. We also presented a task and questions to midwives and surgical nurses who assisted during categories 3 and 4 cesarean sections (elective and scheduled procedures) according to the classification system of he National Institute of Clinical Excellence. The anesthesiologist was asked to place the patient in LLD position after onset of anesthesia and to estimate the LLD angle. A second anesthesiologist measured the angle. The midwives and nurses were asked to place a vacant surgical table at approximately 15 degrees; the angle was then measured. Patient variables (weight, height, anesthetic technique) and staff variables (position, understanding of the purpose of the maneuver, estimated DLL angle, and measured angle) were recorded.

Results: Of 55 women who underwent cesarean sections (98.18% under regional anesthesia), 25 were assessed by staff anesthesiologists and 30 by residents. A total of 14 midwives and 10 surgical nurses participated in the surgical table positioning task and answered questions. The mean (SD) DLL angle estimate of the anesthesiologists was 12.4 degrees (3.4 degrees); the mean measured angle was 7.8 degrees (3.1 degrees). The estimates of staff anesthesiologists were significantly more accurate (P < .001). All the midwives understood the reason for using the DLL position in cesarean section, while only 1 nurse (10%) did (P < .05).

Conclusion: The DLL position angle is overestimated by resident anesthesiologists and midwives. It seems that the use and understanding of DLL positioning could be improved.