Hypotension Associated with Prone Body Position: A Possible Overlooked Postural Hypotension

Tabara, Yasuharu; Tachibana-Iimori, Rieko; Yamamoto, Miyuki; Abe, Michiko; Kondo, Ikuko; Miki, Tetsuro; Kohara, Katsuhiko

doi:10.1291/hypres.28.741

Cited by 37 publications

(39 citation statements)

References 35 publications

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“…[21][22][23] In this study, peripheral SBP and aortic SBP significantly decreased after changing to a prone position in association with AI. Surprisingly, the relationship between aortic SBP and radial SBP2 was not changed in the prone Radial SBP2 and aortic SBP K Kohara et al position.…”

Section: Radial Sbp2 and Aortic Sbp K Kohara Et Alsupporting

confidence: 47%

Clinical usefulness of the second peak of radial systolic blood pressure for estimation of aortic systolic blood pressure

et al. 2009

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Central aortic blood pressure (BP), obtained from radial arterial waveform using the transfer function method (TFM), has been shown to have prognostic value independently of brachial BP. In this study, the relationship between peripheral systolic BP (SBP) and aortic SBP was evaluated. We further investigated whether TFMderived aortic SBP can be estimated by information obtained from the radial waveform. The radial waveform was analysed to obtain the first peak of radial SBP (SBP1), second peak of radial SBP (SBP2), radial augmentation index (AI) (radial (SBP2ÀDBP)/(SBP1ÀDBP) Â 100 and aortic SBP and AI using TFM in 233 subjects in the supine position. Measurements were repeated after changing position to the prone position. The constructed equation was validated in 149 community residents with different backgrounds. Radial SBP2 was closer to TFMderived aortic SBP compared with brachial SBP. TFMderived aortic SBP was approximated by the equation: aortic SBP ¼ 18.9-radial SBP2À0.03 Â HR-0.214 Â radial AI (r 2 ¼ 0.992). The equation was also applicable to predicting aortic SBP in the prone position as well as in different populations (mean difference between predicted aortic SBP and TFM-derived aortic SBP: À0.01 ± 1.34 and 1.05 ± 1.47 mm Hg, respectively). Radial arterial waveform analysis can be used for estimation of TFM-derived aortic SBP.

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Section: Radial Sbp2 and Aortic Sbp K Kohara Et Alsupporting

confidence: 47%

Clinical usefulness of the second peak of radial systolic blood pressure for estimation of aortic systolic blood pressure

et al. 2009

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“…Positioning on the Operating Table There are numerous reports of reduction of evoked potentials during patient positioning for surgery [6,14,21,23,25]. All but one of the patients in these studies sustained a spinal cord injury while they were in the prone position, whereas our patients were in the supine position [1,3,[19][20][21].…”

Section: Spinal Cord Ischemiamentioning

confidence: 78%

“…Specific risk factors, such as spinal stenosis, vascular disease, intraoperative hypotension, or the use of epinephrine in the local anesthetic solution may cause spinal cord ischemia [1,18]. In a case report of spinal cord ischemia after esophagectomy, the patient had a thoracic epidural catheter placed for postoperative pain control [21]. The spinal catheter was used in our second patient but at the lower lumbar level.…”

Section: Spinal Cord Ischemiamentioning

confidence: 94%

Spinal Cord Injury After Extremity Surgery in Children With Thoracic Kyphosis

Pruszczyński

Mackenzie

Rogers

et al. 2015

Clin Orthop Relat Res

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Background Spinal cord injury is a rare complication after lower extremity surgery in children with skeletal dysplasia and thoracic kyphosis. We encountered two patients who had this complication, from among 51 (39 from Nemours/Alfred I. duPont Hospital for Children and 12 from Seattle Children's Hospital) who underwent lower extremity surgery during an 8.5-year period (June 2004 to December 2012). Because spinal cord injury is a devastating complication likely not known to most physicians treating patients with skeletal dysplasias, we sought to examine factors that may contribute to this rare complication. Case Description We performed a retrospective review of two patients with skeletal dysplasia who had paraplegia develop after extremity surgery. Outcome measures included operative time, vital signs, and postsurgery recovery of neurologic deficit. MR images were reviewed. Two patients were found-an 8.5-year-old boy with spondyloepiphyseal dysplasia congenita with a 76°-thoracic kyphosis apex at T4 and a 6.5-year-old boy with mucopolysaccharidosis type 1-H with an 80°-thoracic kyphosis apex at T2. Bilateral proximal femoral osteotomies or bilateral innominate and proximal femoral osteotomies had been performed. The spinal cord injuries occurred at the apex of the kyphosis as determined by clinical examination and MRI assessment. In both patients, the mean arterial blood pressure decreased below 50 mm Hg and might be a factor in the etiology of the paralysis. The first patient recovered motor function in 5 months; the second had no recovery. Literature Review Paraplegia is extremely rare after nonspine operations. Many factors contribute to the risk for a spinal cord event: low mean arterial pressure, duration of the surgery, position on the operating table, the kyphotic spine deformity, or unappreciated vascular disease. Motorevoked potentials and somatosensory-evoked potentials together potentially provide high sensitivity and specificity for predicting a postoperative neurologic deficit. Clinical Relevance Based on our two patients with skeletal dysplasia and a literature review of patients with hyperkyphosis undergoing extremity surgery, the surgeon must be aware of the risk of spinal cord injury. Careful preoperative assessment possibly including MRI of the spine is recommended. Mean arterial pressure should be maintained at a safe level; neuromonitoring should be considered.

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“…[ Table 2 about here] Whilst significantly lower HR in relation to body position has been reported in young [4] and middle aged adults [6] this was not found in older people. As well this study found no significant difference in the HR of older people when comparing LSL and RSL.…”

Section: Discussionmentioning

confidence: 94%

“…Reported findings related to body position and cardio-respiratory factors have varied for healthy, young adults [3][4][5] and one study has investigated these factors in a middle aged group [6].…”

Section: Introductionmentioning

confidence: 99%

Body position and cardio-respiratory variables in older people

Gordon

Jones

Sealey

et al. 2011

Archives of Gerontology and Geriatrics

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Background: Older people are placed in different body positions for medical, nursing and physiotherapy intervention.Objective: To investigate the effect of body position on cardio-respiratory variables in active older people.Design: Experimental laboratory study.Setting: Research was undertaken at the James Cook University, Physiotherapy Clinic.Subjects: Twenty-six active people aged 60 years and over.Methods: Heart rate, systolic and diastolic blood pressure and oxygen saturation were measured every two minutes over a ten minute period in five standardized positions, sitting, right side lying, left side lying, supine and supine with the head 20 degrees below the level of the body. Rate pressure product and mean arterial pressure were calculated. Smoking history, medication use, health conditions and activity level were recorded. Height, weight and body fat were measured.Results: Left and right side lying produced significantly lower diastolic and systolic blood pressure, rate pressure product and mean arterial pressure than supine with the head down. Older, healthy people have decreased forced vital capacity and forced expiratory volume after one second in side lying when compared to sitting [16]. Further healthy, seated older subjects 3 (>65 years) have significant impairment of ventilation distribution to dependent lung zones [17]. Body position and cardio-respiratory variables in older peopleOlder people exhibit significant increased preference for the right side sleep position [18]. This has been postulated to be due to age related alterations in cardiovascular function [18] or compression from other structures causing reduction in ventricular distensibility [19].This study investigates the effect of five standardised body positions on cardio-respiratory variables in a group of healthy, older people. Comparisons are made to previously reported findings for young and middle aged healthy people. MethodologyThe method of this observational study largely replicates Jones & Dean [4]. It is described here for the convenience of the reader and to identify alterations for this study.Participants were recruited from four Probus clubs (a community organisation for people aged over 60 years) in Townsville, Australia. Human research ethics approval was provided by James Cook University and signed informed consent was gained prior to participation.Participants were eligible to participate if they were over 60 years of age. A screening questionnaire (see Appendix 1 in the supplementary data on the journal website) was completed by participants to identify the presence of any physical or medical condition which would prevent participants from comfortably adopting each position included in the study for 20 minutes.Information regarding smoking history, usual exercise level, medication use, medical history and recent illness was also collected.

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Hypotension Associated with Prone Body Position: A Possible Overlooked Postural Hypotension

Cited by 37 publications

References 35 publications

Clinical usefulness of the second peak of radial systolic blood pressure for estimation of aortic systolic blood pressure

Clinical usefulness of the second peak of radial systolic blood pressure for estimation of aortic systolic blood pressure

Spinal Cord Injury After Extremity Surgery in Children With Thoracic Kyphosis

Body position and cardio-respiratory variables in older people

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