This seemed to provide satisfactory surgical conditions and has proved to be a safe anaesthetic with minimal risk of hypotension and high spinal block. The technique is as follows. The patient remains seated for 5 minutes with a nurse close by. She then lies flat with a left lateral tilt and a slight head-up tilt. Her head is placed on a pillow.
Surgery proceeds as usual.
In only 3 of 100 consecutive cases was the anaesthetic judged inadequate by the surgeon. In no cases was the procedure abandoned. No cases of total spinal were seen and ephedrine was not needed to counteract hypotension. In only 5 women did the SBP drop by 39mmHg or more and 2 of these were associated with brisk uterine haemorrhage. All responded to intravenous fluids.