Cardiorespiratory Effects of the Sitting Position in Neurosurgery

Dalrymple, D.G.; MacGowan, Simon W.; Macleod, G.F.

doi:10.1093/bja/51.11.1079

Cited by 49 publications

(6 citation statements)

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“…Previous studies on the respiratory effect of sitting position during neurosurgery reported the decrease in lung oxygenation and increase in dead-space ventilation, which are partly consistent with the results of the present study [ 8 , 9 ]. In the present study, the dead-space ventilation was increased in the normocapnia group but the oxygenation index was not changed in the sitting position.…”

Section: Discussionsupporting

confidence: 93%

“…However, hypoventilation of the lungs may result in atelectasis and increase in intrapulmonary shunt, which leads to hypoxemia and lung injury [ 6 , 7 ]. In previous studies on respiratory effect of the sitting position during neurosurgery, sitting position was associated with decreased arterial oxygen tension (PaO 2 ) and increased dead-space ventilation (Vd/Vt) [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

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Effect of Mild Hypercapnia on Lung Oxygenation in Sitting Position During Shoulder Arthroscopy Under General Anesthesia

Kwak

Lee

et al. 2017

Med Sci Monit

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BackgroundMild hypercapnia is permitted during surgeries in sitting position under general anesthesia to maintain cerebral regional oxygen saturation (rSO2). However, since hypoventilation may cause gas exchange impairment, we evaluated effects of mild hypercapnia on lung oxygenation during shoulder arthroscopy in sitting position.Material/MethodsForty patients were randomly allocated to a normocapnia group (ETCO2 35 mmHg, n=20) or a hypercapnia group (45 mmHg, n=20). The mean arterial pressure (MAP), heart rate (HR), and rSO2 were measured 5 min after intubation in supine position (T0), and at 2, 4, 6, 8, 10, 20, 30, 40, 50, and 60 min of remaining in sitting position (T1–10). Arterial blood gas was analyzed at T0 and T5. The oxygenation index (PaO2/FiO2) and dead-space ventilation ratio (Vd/Vt) were calculated.ResultsThere were no differences in PaO2/FiO2 at T0 and T5 between the 2 groups. At T5, the Vd/Vt was higher in the normocapnia group than in the hypercapnia group (p=0.04). The Vd/Vt at T5 increased from T0 in the normocapnia group. The incidence of cerebral desaturation in the hypercapnia group (0/20) was lower than in the normocapnia group (5/20) (p=0.047). Among rSO2, MAP, and HR, only changes in rSO2 over time between the 2 groups differed significantly (p=0.048).ConclusionsMild hypercapnia did not decrease lung oxygenation in sitting position, probably due to attenuation of the increase in dead-space ventilation ratio. Since hypercapnia maintained rSO2 without changes in oxygenation index and hemodynamic parameters, mild hypercapnia should be maintained during shoulder arthroscopy in sitting position under general anesthesia.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Effect of Mild Hypercapnia on Lung Oxygenation in Sitting Position During Shoulder Arthroscopy Under General Anesthesia

Kwak

Lee

et al. 2017

Med Sci Monit

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“…The effects of an intraoperative, semi-seated position on the gas exchange are also studied in neurosurgical patients [ 66 ]. The small amount of available data revealed an improvement of oxygenation in these patients.…”

Section: Backrest Elevation Positionmentioning

confidence: 99%

S2e guideline: positioning and early mobilisation in prophylaxis or therapy of pulmonary disorders

et al. 2015

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The German Society of Anesthesiology and Intensive Care Medicine (DGAI) commissioneda revision of the S2 guidelines on “positioning therapy for prophylaxis or therapy of pulmonary function disorders” from 2008. Because of the increasing clinical and scientificrelevance the guidelines were extended to include the issue of “early mobilization”and the following main topics are therefore included: use of positioning therapy and earlymobilization for prophylaxis and therapy of pulmonary function disorders, undesired effects and complications of positioning therapy and early mobilization as well as practical aspects of the use of positioning therapy and early mobilization. These guidelines are the result of a systematic literature search and the subsequent critical evaluation of the evidence with scientific methods. The methodological approach for the process of development of the guidelines followed the requirements of evidence-based medicine, as defined as the standard by the Association of the Scientific Medical Societies in Germany. Recently published articles after 2005 were examined with respect to positioning therapy and the recently accepted aspect of early mobilization incorporates all literature published up to June 2014.

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“…The resulting postural reduction in stroke volume (SV) and cardiac output (CO) impacts the circulation (Dalrymple et al, 1979; Porter et al, 1999; Buhre et al, 2000; Truijen et al, 2012). In healthy awake humans, baroreceptor reflex-mediated sympathetic activation with an increase in heart rate (HR) and vascular tone maintains mean arterial pressure (MAP), but induction of anesthesia with propofol attenuates this adaptive response.…”

Section: Introductionmentioning

confidence: 99%

“…While several studies focused on the perioperative hemodynamic challenge of the beach-chair position (Dalrymple et al, 1979; Porter et al, 1999; Buhre et al, 2000; Jeong et al, 2012; Moerman et al, 2012), no attention has been paid to the position of the patient during induction of anesthesia. It remains unsettled whether induction of anesthesia in the reclining vs. sitting beach-chair position secures cerebrovascular hemodynamics.…”

Section: Introductionmentioning

confidence: 99%

Cardiovascular consequence of reclining vs. sitting beach-chair body position for induction of anesthesia

et al. 2014

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The sitting beach-chair position is regularly used for shoulder surgery and anesthesia may be induced in that position. We tested the hypothesis that the cardiovascular challenge induced by induction of anesthesia is attenuated if the patient is placed in a reclining beach-chair position. Anesthesia was induced with propofol in the sitting beach-chair (n = 15) or with the beach-chair tilted backwards to a reclining beach-chair position (n = 15). The last group was stepwise tilted to the sitting beach-chair position prior to surgery. Hypotension was treated with ephedrine. Continuous hemodynamic variables were recorded by photoplethysmography and frontal cerebral oxygenation (ScO2) by near infrared spectroscopy. Significant differences were only observed immediately after the induction when patients induced in a reclining beach-chair position had higher mean arterial pressure (MAP) (35 ± 12 vs. 45 ± 15 % reduction from baseline, p = 0.04) and ScO2 (7 ± 6 vs. 1 ± 8% increase from baseline, p = 0.02) and received less ephedrine (mean: 4 vs. 13 mg, p = 0.048). The higher blood pressure and lower need of vasopressor following induction of anesthesia in the reclining compared to the sitting beach-chair position indicate more stable hemodynamics with the clinical implication that anesthesia should not be induced with the patient in the sitting position.

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Cardiorespiratory Effects of the Sitting Position in Neurosurgery

Cited by 49 publications

References 0 publications

Effect of Mild Hypercapnia on Lung Oxygenation in Sitting Position During Shoulder Arthroscopy Under General Anesthesia

Effect of Mild Hypercapnia on Lung Oxygenation in Sitting Position During Shoulder Arthroscopy Under General Anesthesia

S2e guideline: positioning and early mobilisation in prophylaxis or therapy of pulmonary disorders

Cardiovascular consequence of reclining vs. sitting beach-chair body position for induction of anesthesia

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