Anesthesia and Surgery in the Seated Position: Analysis of 554 Cases

Matjasko, Jane; Petrozza, Patricia H.; Cohen, Melvin R.; Steinberg, Polly

doi:10.1227/00006123-198511000-00001

Cited by 169 publications

(71 citation statements)

References 15 publications

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“…As much as 1500 ml may be sequestered in venous system of lower limbs because of the effect of the gravity [8]. Different authors have described hypotension in different ranges in their studies [1,[9][10][11] but in our study hypotension was considered if there was decrease of 20% or more in systolic blood pressure from ward pressure. Systolic and diastolic blood pressure decreased statistically significantly during positioning and till 30 min.…”

Section: Discussionmentioning

confidence: 99%

A prospective study observing outcome following posterior fossa craniotomy in patients with sitting position

Kore¹,

Waghalkar²,

Shetty³

et al. 2016

Int J of Biomed & Adv Res

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Aims and Objective: To assess the outcome following posterior fossa craniotomy in sitting position with respect to hemodynamic changes as well as intra and post operative complications. Material and Method: The present study was conducted in150 adult patients undergoing posterior fossa craniotomy in sitting position under general anaesthesia. Induction was done with thiopentone sodium 5mg/kg. Neuromuscular blockade was achieved with vecuronium bromide 0.1mg/kg to facilitate intubation. Radial arterial line was inserted preferably in left hand side for invasive blood pressure monitoring. Sitting position was given to patients' slowly over 20-30 minutes. Vital of the patients were monitored during and after giving sitting position. Patients were observed in ICU for first 48 hrs for neurological status, cardiovascular status, respiratory and surgical complications. Results: We found significant hemodynamic changes during and after giving sitting position to the patients which returned back to normal after 2 hrs of position. There were no perioperative cardiac events and neurological alteration. The incidence of venous air embolism was 5.3% and it was not associated with any postoperative morbidity and mortality. Other complications observed were pneumocephalous (0.7%), tongue oedema (2%) and glossopharyngeal nerve palsy (0.7%). Conclusions: Use of sitting position for posterior fossa surgery is safe anesthetic techniques and presents unique challenges for the anesthetist; taking measures to minimize hypotension and postoperative complications.

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Section: Discussionmentioning

confidence: 99%

A prospective study observing outcome following posterior fossa craniotomy in patients with sitting position

Kore¹,

Waghalkar²,

Shetty³

et al. 2016

Int J of Biomed & Adv Res

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“…The most feared complication of this position is venous air embolism. Air embolism may occur in any operation with an open vein and a gradient of venous pressure between the surgical site and the heart [8][9][10][11][12] . The incidence in the horizontal position is, however, lower.…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, we have to consider that not all departments have such modern methods of monitoring. The incidence of complications of right atrial catheter may be high and the volume of air removed through it can be minimal [9][10][11][12]23 .…”

Section: Discussionmentioning

confidence: 99%

“…This position permits drainage of blood and cerebrospinal fluid (CSF) allowing a better visualization and dissection of the cranial nerves, easier hemostasia and reduces venous bleeding. The main disadvantages of this position are the increased risk of venous air embolism and hemodynamic instability, especially in elderly patients [8][9][10][11][12] . The aim of this study was to evaluate the results of surgical treatment of VS in patients operated on through the retrosigmoid-transmeatal approach, in the dorsal decubitus position (mastoid position).…”

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confidence: 99%

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Acoustic neuroma (vestibular schwannoma): surgical results on 240 patients operated on dorsal decubitus position

Cardoso

Fernandes

Ramina

et al. 2007

Arq. Neuro-Psiquiatr.

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-Objective: To evaluate the result of the surgical treatment of vestibular schwannoma (VS) operated in dorsal decubitus (mastoid position). Method: 240 patients with a VS underwent a retrosigmoid craniotomy for tumor resection in dorsal decubitus (mastoid position). The function of 7 th and 8 th cranial nerves was monitored during surgery and the opened internal auditory canal (IAC) was reconstructed using a vascularized dura flap, muscle and fibrin glue. Results: Complete tumor removal was achieved in 99% of the cases, with a mortality of 1.6%. The facial nerve function was preserved in 85% of cases and hearing in 40% of the patients (with preoperative hearing) with tumors of up 1.5 cm in diameter. The incidence of cerebrospinal fluid leak was 5.8% and meningitis 2.9%. Venous air embolism was registered in 3% of cases; it was not associated to mortality. Conclusion: Surgical removal of VS in dorsal position has several advantages; the morbidity and mortality are very low.KEY WORDS: acoustic neuroma, vestibular schwannoma, mastoid position, venous air embolism.Neurinoma do acústico (schwannoma do vestibular): resultados do tratamento cirúrgico de 240 pacientes operados na posição de decúbito dorsal RESUMO -Objetivo: Avaliar o resultado do tratamento cirúrgico de pacientes portadores de schwannoma do vestibular (SV) operados em decúbito dorsal (posição de mastóide). Método: 240 pacientes foram submetidos a craniotomia retrosigmóide na posição de mastóide. A função do VII e VIII nervos cranianos foi monitorizada durante a cirurgia e a reconstrução da abertura do conduto auditivo interno foi realizada com retalho vascularizado de dura-mater, músculo e cola de fibrina. Resultados: A exérese foi completa em 99% dos casos, com mortalidade de 1,6%. Houve preservação da função do nervo facial em 85% dos casos e da audição em 40% dos pacientes com audição prévia e tumores menores de 1,5 cm. A incidência de fístula liquórica foi 5,8% e meningite 2,9%. Embolia gasosa foi registrada em 3% dos casos, não associada à mortalidade. Conclusão: O tratamento cirúrgico dos SV utilizando-se a posição de mastóide tem várias vantagens, com baixa morbidade e mortalidade. PALAVRAS-CHAVE: neurinoma do acústico, schwannoma vestibular, posição de mastóide, embolia gasosa.

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“…The bone has been noted to be the source of VAE in 43% of all sitting craniotomies. 16 The incidence of neurosurgical skull base VAE in any head-elevated position has been noted to be 28% for sitting craniotomies compared with 5% for supine and prone positions. 7 Because many skull base resections involve the jugular vein and cavernous or sigmoid sinuses, and considering that some positioning requires slight head elevation, the risk of passive air entrainment is increased.…”

Section: Patient Positioningmentioning

confidence: 99%

Perioperative management of complex skull base surgery: the anesthesiologist's point of view

Jellish¹,

Murdoch²,

Jp³

2002

FOC

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The anesthetic management of complex skull base surgical procedures provides unique problems and concerns for the neuroanesthesiologist. Positioning to access the skull base could put the patient at risk for peripheral nerve injury and some of the positions may increase the risk for air emboli. In addition, tumor pathology and involvement with vital structures could increase the chances for substantive blood loss, destruction of associated nerves or vessels, and may require temporary occlusion of the carotid artery necessitating intraoperative neuroprotection. Neurophysiological monitors may also be used to safeguard nerve function and anesthetic techniques must be adjusted to accommodate their use. Finally, postoperative morbidity may be affected by surgical approach to the skull base and the anesthesiologist should be aware of which approach may produce a greater incidence of pain, nausea, and vomiting in the postoperative period. The authors discuss the anesthetic concerns and management for complex cranial base surgery. Different approaches will be discussed and comparisons of perioperative parameters between these approaches will be made with data provided by retrospective chart review of more than 600 skull base procedures performed at the authors' institution over the last 10 years. This information should help guide decision making concerning anesthetic management for these skull base procedures.

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Anesthesia and Surgery in the Seated Position: Analysis of 554 Cases

Cited by 169 publications

References 15 publications

A prospective study observing outcome following posterior fossa craniotomy in patients with sitting position

A prospective study observing outcome following posterior fossa craniotomy in patients with sitting position

Acoustic neuroma (vestibular schwannoma): surgical results on 240 patients operated on dorsal decubitus position

Perioperative management of complex skull base surgery: the anesthesiologist's point of view

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