DOI: https://doi.org/10.15587/2313-8416.2015.39269

Postural hemodynamic changes after turning to prone position

Микола Віталійович Лизогуб

Abstract


Background of study. Prone position is one of the most complex positions for anesthesiologist as it is accompanied by several physiological changes that can lead to specific complications. Hemodynamic changes are most controversial.

Aim of study was to establish hemodynamic changes in non-anaesthetized patients in prone position depending on body mass index.

Material and methods. We examined central hemodynamics in 40 patients the day before surgery using thoracic rheography in supine position, in prone position 5 min after turning and in prone position 20 min after turning. Patients were divided into 2 groups according to body mass index (18-25 and 26-35).

Results. Patients with normal body weight did not have any hemodynamic changes after turning to prone position. Patients with increased body weight had higher cardiac index. After turning to prone position obese patients’ cardiac output and cardiac index reduced 22% comparing with supine position. After 20 min in prone position these hemodynamic parameters were found to be reduced to the same level.

Conclusion. Significant hemodynamic changes after turning from supine to prone position were revealed only in patients with increased body mass index. In these patients cardiac index in prone position was reduced by 22% comparing to supine position


Keywords


hemodynamics; supine position; prone position; thoracic rheography; body mass index

References


Edgcombe, H., Carter, K., Yarrow, S. (2008). Anaesthesia in the prone position. British Journal of Anaesthesia, 100 (2), 165–183. doi: 10.1093/bja/aem380

Backofen, J. E., Backofen, S. J. (1985). Hemodynamic changes with prone positioning during general anesthesia. Anesth Analg., 64, 194.

Dharmavaram, S., Jellish, W. S., Nockels, R. P. et al. (2006). Effect of Prone Positioning Systems on Hemodynamic and Cardiac Function During Lumbar Spine Surgery: An Echocardiographic Study. Spine, 31 (12), 1388–1393. doi: 10.1097/01.brs.0000218485.96713.44

Hatada, T., Kusunoki, M., Sakiyama, T. et al. (1991). Hemodynamics in the prone jackknife position during surgery. The American Journal of Surgery, 162 (1), 55–58. doi: 10.1016/0002-9610(91)90202-o

Wadsworth, R., Anderton, J. M., Vohra, A. (1996). The effect of four different surgical prone positions on cardiovascular parameters in healthy volunteers. Anaesthesia, 51 (9), 819–822. doi: 10.1111/j.1365-2044.1996.tb12608.x

Sudheer, P. S., Logan, S. W., Ateleanu, B., Hall, J. E. (2006). Haemodynamic effects of the prone position: a comparison of propofol total intravenous and inhalation anaesthesia. Anaesthesia, 61 (2), 138–141. doi: 10.1111/j.1365-2044.2005.04464.x

Wu, C. Y., Lee, T. S., Chan, K. C. et al. (2012). Does targeted pre-load optimisation by stroke volume variation attenuate a reduction in cardiac output in the prone position. Anaesthesia, 67 (7), 760–764. doi: 10.1111/j.1365-2044.2012.07116.x

Yokoyama, M., Ueda, W., Hirakawa, M., Yamamoto, H. (1991). Hemodynamic effect of the prone position during anesthesia. Acta Anaesthesiologica Scandinavica, 35 (8), 741–744. doi: 10.1111/j.1399-6576.1991.tb03382.x

Toyota, S., Amaki, Y. (1998). Hemodynamic evaluation of the prone position by transesophageal echocardiography. Journal of Clinical Anesthesia, 10 (1), 32–35. doi: 10.1016/s0952-8180(97)00216-x

Leslie, K., Wu, C., Bjorksten, A. et al. (2011). Cardiac output and propofol concentrations in prone surgical patients. Anaesth Intensive Care, 39 (5), 868–874.

Schonauer, C., Bochetti, A., Barbagallo, G. et al. (2004). Positioning on surgical table. European Spine Journal, 13 (S01), 850–855. doi: 10.1007/s00586-004-0728-y

Park, C. K. (2000) The effect of patient positioning on intraabdominal pressure and blood loss in spinal surgery. Anesthesia & Analgesia, 91 (3), 552–557. doi: 10.1213/00000539-200009000-00009

Pump, B., Talleruphuus, U., Christensen, N. J. et al. (2002). Effects of supine, prone, and lateral positions on cardiovascular and renal variables in humans. American Journal of Physiology - Regulatory, Integrative and Comparative Physiology, 283 (1), 174–180. doi: 10.1152/ajpregu.00619.2001

Ozkose, Z., Ercan, B., Unal, Y. et al. (2001). Inhalation versus total intravenous anesthesia for lumbar disc herniation: comparison of hemodynamic effects, recovery characteristics, and cost. Journal of Neurosurgical Anesthesiology, 13 (4), 296–302.

Ho, J..D., Dawes, D. M., Moore, J. C. et al. (2011). Effect of position and weight force on inferior vena cava diameter--implications for arrest-related death / // Forensic Science International, 212 (1-3), 256–259. doi: 10.1016/j.forsciint.2011.07.001

Han, I. H., Son, D. W., Nam, K. H. et al. (2012). The effect of body mass index on intra-abdominal pressure and blood loss in lumbar spine surgery. Journal of Korean Neurosurgical Society, 51 (2), 81–85. doi: 10.3340/jkns.2012.51.2.81

Lee, T. C., Yang, L. C., Chen, H. J. (1998). Effect of patient position and hypotensive anesthesia on inferior vena caval pressure. Spine, 23 (8), 941–947. doi: 10.1097/00007632-199804150-00019


GOST Style Citations


1. Edgcombe, H. Anaesthesia in the prone position [Text] / H. Edgcombe, K. Carter S. Yarrow // British Journal of Anaesthesia. – 2008. – Vol. 100, Issue 2. – Р. 165–183. doi: 10.1093/bja/aem380 

2. Backofen, J.E. Hemodynamic changes with prone positioning during general anesthesia [Text] / J. E. Backofen, S. J. Backofen // Anesth Analg. – 1985. – Vol. 64. – Р. 194.

3. Dharmavaram ,S. Effect of Prone Positioning Systems on Hemodynamic and Cardiac Function During Lumbar Spine Surgery: An Echocardiographic Study [Text] / S. Dharmavaram, W. S. Jellish, R. P. Nockels et al. // Spine. – 2006. – Vol. 31, Issue 12. – Р. 1388–1393. doi: 10.1097/01.brs.0000218485.96713.44 

4. Hatada, T.Hemodynamics in the prone jackknife position during surgery [Text] / T. Hatada, M. Kusunoki, T. Sakiyama et al. // The American Journal of Surgery. – 1991. – Vol. 162, Issue 1. – Р. 55–58. doi: 10.1016/0002-9610(91)90202-o 

5. Wadsworth, R. The effect of four different surgical prone positions on cardiovascular parameters in healthy volunteers [Text] / R. Wadsworth, J. M. Anderton, A. Vohra // Anaesthesia. – 1996. – Vol. 51, Issue 9. – Р. 819–822. doi: 10.1111/j.1365-2044.1996.tb12608.x 

6. Sudheer, P. S. Haemodynamic effects of the prone position: a comparison of propofol total intravenous and inhalation anaesthesia [Text] / P. S. Sudheer, S. W. Logan, B. Ateleanu, J. E. Hall // Anaesthesia. – 2006. – Vol. 61, Issue 2. – Р. 138–141. doi: 10.1111/j.1365-2044.2005.04464.x 

7. Wu, C. Y. Does targeted pre-load optimisation by stroke volume variation attenuate a reduction in cardiac output in the prone position [Text] / C. Y. Wu, T. S. Lee, K. C. Chan et al. // Anaesthesia. – 2012. – Vol. 67, Issue 7. – Р. 760–764. doi: 10.1111/j.1365-2044.2012.07116.x 

8. Yokoyama, M. Hemodynamic effect of the prone position during anesthesia [Text] / M. Yokoyama, W. Ueda, M. Hirakawa, H. Yamamoto // Acta Anaesthesiologica Scandinavica. – 1991. – Vol. 35, Issue 8. – Р. 741–744. doi: 10.1111/j.1399-6576.1991.tb03382.x 

9. Toyota, S. Hemodynamic evaluation of the prone position by transesophageal echocardiography [Text] / S. Toyota, Y. Amaki // Journal of Clinical Anesthesia. – 1998. – Vol. 10, Issue 1. – Р. 32–35. doi: 10.1016/s0952-8180(97)00216-x 

10. Leslie, K. Cardiac output and propofol concentrations in prone surgical patients [Text] / K. Leslie, C. Y. Wu, A. R. Bjorksten et al. // Anaesth Intensive Care. – 2011. – Vol. 39, Issue 5. – Р. 868–874.

11. Schonauer, C. Positioning on surgical table [Text] / C. Schonauer, A. Bochetti, G. Barbagallo et al. // European Spine Journal. – 2004. – Vol. 13, Issue S01. – Р. 850–855. doi: 10.1007/s00586-004-0728-y 

12. Park, C. K. The effect of patient positioning on intraabdominal pressure and blood loss in spinal surgery [Text] / C. K. Park // Anesthesia & Analgesia. – 2000. – Vol. 91, Issue 3. – P. 552–557. doi: 10.1213/00000539-200009000-00009 

13. Pump, B. Effects of supine, prone, and lateral positions on cardiovascular and renal variables in humans [Text] / B. Pump, U. Talleruphuus, N. J. Christensen et al. // American Journal of Physiology - Regulatory, Integrative and Comparative Physiology. – 2002. – Vol. 283, Issue 1. – Р. 174–180. doi: 10.1152/ajpregu.00619.2001 

14. Ozkose, Z. Inhalation versus total intravenous anesthesia for lumbar disc herniation: comparison of hemodynamic effects, recovery characteristics, and cost [Text] / Z. Ozkose, B. Ercan, Y. Unal et al. // Journal of Neurosurgical Anesthesiology. – 2001. – Vol. 13, Issue 4. – Р. 296–302.

15. Ho, J. D. Effect of position and weight force on inferior vena cava diameter--implications for arrest-related death [Text] / J. D. Ho, D. M. Dawes, J. C. Moore et al. // Forensic Science International. – 2011. – Vol. 212, Issue 1-3. – Р. 256–259. doi: 10.1016/j.forsciint.2011.07.001 

16. Han, I. H. The effect of body mass index on intra-abdominal pressure and blood loss in lumbar spine surgery [Text] / I. H. Han, D. W. Son, K. H. Nam et al. // Journal of Korean Neurosurgical Society. – 2012. – Vol. 51, Issue 2. – Р. 81–85. doi: 10.3340/jkns.2012.51.2.81 

17. Lee, T. C. Effect of patient position and hypotensive anesthesia on inferior vena caval pressure [Text] / T. C. Lee, L. C. Yang, H. J. Chen // Spine. – 1998. – Vol. 23, Issue 8. – Р. 941–947. doi: 10.1097/00007632-199804150-00019 






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