Faculty Opinions recommendation of Trendelenburg position with hip flexion as a rescue strategy to increase spinal anaesthetic level after spinal block.
Bibliographic record
Abstract
BACKGROUND: When the level achieved by a spinal anaesthetic is too low to perform surgery, patients are usually placed in the Trendelenburg position. However, cephalad spread of the hyperbaric spinal anaesthetics may be limited by the lumbar lordosis. The Trendelenburg position with the lumbar lordosis flattened by hip flexion was evaluated as a method to extend the analgesic level after the administration of hyperbaric local anaesthetic.METHODS: When the pinprick block level was lower than T10 5 min after intrathecal injection of hyperbaric bupivacaine (13 mg), patients were recruited to the study and randomly allocated to one of the two positions: the Trendelenburg position with hip flexion (hip flexion group, n = 20) and the Trendelenburg position without hip flexion (control group, n = 20). Each assigned position was maintained for 5 min and then patients were returned to the horizontal supine position. Spinal block level was assessed by pinprick, cold sensation, and modified Bromage scale at intervals for the following 150 min.RESULTS: The maximum level of pinprick and cold sensory block [median (range)] was higher in the hip flexion group [T4 (T8-C6) and T3 (T6-C2)] compared with the control group [T7 (T12-T4) and T5 (T11-T3)] (P < 0.001). The maximum motor blockade median (range) was not different between the two groups being 3 (3-3) in the hip flexion group vs 3 (0-3) in the control group.CONCLUSIONS: When the level of spinal anaesthesia is lower than required, flexion of the hips in the Trendelenburg position may be useful as a strategy attempt to increase the level of the block. PMID: 17283005
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.004 | 0.003 |
| Insufficient payload (model declined to judge) | 0.279 | 0.128 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".