Prone Versus Sitting Position in Neurosurgery-Differences in Patients' Hemodynamic Management

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Luostarinen , T , Lindroos , A-C , Niiya , T , Silvasti-Lundell , M , Schramko , A , Hernesniemi , J , Randell , T & Niemi , T 2017 , ' Prone Versus Sitting Position in Neurosurgery-Differences in Patients' Hemodynamic Management ' , World Neurosurgery , vol. 97 , pp. 261-266 . https://doi.org/10.1016/j.wneu.2016.10.005

Title: Prone Versus Sitting Position in Neurosurgery-Differences in Patients' Hemodynamic Management
Author: Luostarinen, Teemu; Lindroos, Ann-Christine; Niiya, Tomohisa; Silvasti-Lundell, Marja; Schramko, Alexey; Hernesniemi, Juha; Randell, Tarja; Niemi, Tomi
Contributor organization: Department of Diagnostics and Therapeutics
Clinicum
Anestesiologian yksikkö
Neurokirurgian yksikkö
Department of Neurosciences
HUS Perioperative, Intensive Care and Pain Medicine
HUS Neurocenter
Date: 2017-01
Language: eng
Number of pages: 6
Belongs to series: World Neurosurgery
ISSN: 1878-8750
DOI: https://doi.org/10.1016/j.wneu.2016.10.005
URI: http://hdl.handle.net/10138/233950
Abstract: OBJECTIVE: Neurosurgery in general anesthesia exposes patients to hemodynamic alterations in both the prone and the sitting position. We aimed to evaluate the hemodynamic profile during stroke volume-directed fluid administration in patients undergoing neurosurgery either in the sitting or the prone position. METHODS: In 2 separate prospective trials, 30 patients in prone and 28 patients in sitting position were randomly assigned to receive either Ringer acetate (RAC) or hydroxyethyl starch (HES; 130 kDa/0.4) for optimization of stroke volume. After combining data from these 2 trials, 2-way analysis of variance was performed to compare patients' hemodynamic profile between the 2 positions and to evaluate differences between RAC and HES consumption. RESULTS: To achieve comparable hemodynamics during surgery, a higher mean cumulative dose of RAC than HES was needed (679 mL +/- 390 vs. 455 mL +/- 253; P <0.05). When fluid consumption was adjusted with weight, statistical difference was lost. Fluid administration did not differ between the prone and sitting position. Mean arterial pressure was lower and cardiac index and stroke volume index were higher over time in patients in the sitting position. CONCLUSIONS: The sitting position does not require excess fluid treatment compared with the prone position. HES is slightly more effective than RAC in achieving comparable hemodynamics, but the difference might be explained by patient weight. With goal-directed fluid administration and moderate use of vasoactive drugs, it is possible to achieve stable hemodynamics in both positions.
Subject: Fluid administration
Hemodynamics
Neurosurgery
Prone position
Sitting position
VENOUS AIR-EMBOLISM
CEREBRAL PERFUSION-PRESSURE
HYDROXYETHYL STARCH
SEMISITTING POSITION
RINGERS ACETATE
SURGERY
RESUSCITATION
VOLUME
ANESTHESIA
SAFETY
3126 Surgery, anesthesiology, intensive care, radiology
Peer reviewed: Yes
Usage restriction: openAccess
Self-archived version: publishedVersion


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