NCT06889337

A Comparative Study of Supine Position and the Head Elevated Position on the Level of Sensory Block After Spinal Anesthesia in Morbidly Obese Parturient Undergoing Elective Cesarean Delivery

Completed NA Last updated 21 March 2025

What this trial tests

NA trial testing head elevated laryngoscopy position by Oxford pillow in High BMI in 90 participants. Completed in 10 December 2024.

Timeline

1 May 2023

Primary endpoint
11 July 2024

10 December 2024

Quick facts

Lead sponsor	Hamad Medical Corporation
Phase	NA
Status	Completed
Study type	INTERVENTIONAL
Allocation	randomized
Design	parallel
Masking	none
Primary purpose	supportive care
Enrollment	90
Start date	1 May 2023
Primary completion	11 July 2024
Estimated completion	10 December 2024
Sites	1 location across Qatar

Drugs / interventions tested

• head elevated laryngoscopy position by Oxford pillow

Conditions studied

• High BMI — all drugs for High BMI →

Sponsor

Hamad Medical Corporation — full company profile →

Who can join

18 and older, female only, with High BMI. Patients with the condition only — healthy volunteers not accepted.

Sponsor's own description

The sniffing position defined as neck flexion with upper cervical extension, is traditionally recommended for general anesthesia induction, as it improves laryngoscopic views. However, the head elevation beyond the sniffing position, also known as ramped position or head elevated laryngoscopy position, usually achieved by specially designed pillows such as the Oxford head elevating laryngoscopy pillow (Alma Medical,Oxford, UK) or the Troop® elevation pillow (Mercury Medical, Clearwater, FL, USA)has been shown to not only increase respiratory reserve but also to improve laryngeal views in patients undergoing bariatric surgery. Additionally it helps in pre-oxygenating the patient more efficiently by keeping the airway patent and provides easier bag-mask ventilation.

It may also benefit the term parturient in a similar way by improving functional residual capacity (FRC), ventilation and comfort. However, this positon may affect the cephalad spread of the intrathecal local anesthetic.

Two earlier studies looked at the intrathecal local anesthetic spread in obstetric patients when placed in the head elevated laryngoscopy position, and both suggested poor cephalad spread, with patients requiring higher supplementation.

However, both studies excluded morbidly obese patients. The Investigators hypothesized that in obese parturients with BMI more than or equal 40, higher intra-abdominal pressures and possibly lower CSF volumes will counteract the poor cephalad spread associated with this position. The aim of this study is to determine the effect of a ramped position on intrathecal local anesthetic spread in the morbidly obese term parturients with BMI more than or equal 40 undergoing elective Cesarean delivery(CD).

Publications & conference data

1 peer-reviewed publication reference this trial (live from Europe PMC):

1. Comparison of supine vs head-elevated position on sensory block height following combined spinal epidural anaesthesia in Class III obese parturients undergoing elective caesarean delivery- a randomized controlled trial.
   Elfil H, Afzal A, Valappil SS, Mathew GV, et al · · 2026 · PMID 41840470 · DOI 10.1186/s12871-026-03756-5