scholarly journals Effects of Desflurane Versus Propofol Anesthesia on Regional Cerebral Oxygenation during Spinal Surgery in the Prone Position

2021 ◽  
pp. 1-6
Author(s):  
Stachtari Chrysoula ◽  
Koraki Eleni ◽  
Stachtari Chrysoula ◽  
Bagntasarian Stella ◽  
Gkiouliava Anna ◽  
...  
Keyword(s):  
Prone Position ◽  
Supine Position ◽  
Spinal Surgery ◽  
Cerebral Oxygenation ◽  
Demographic Data ◽  
Prone Positioning ◽  
Anaesthetic Agents ◽  
Oxygen Administration ◽  
Hemodynamic Variables ◽  
Significant Difference

Context: Postural change during anaesthesia has a complex effect on systemic and cerebral circulations. Aim: The goal of the study was to evaluate the effects of desflurane and propofol on cerebral oxygenation during spinal surgery in the prone position. Settings and Design: A prospective randomized double-blinded trial. Methods and Materials: Fifty-two patients scheduled for spinal surgery were randomly allocated to propofol (n=25) and desflurane (n=27) groups. Anaesthetic agents were maintained to obtain a bispectral index of 50-55. SAP, DAP, HR, SPO2, ETCO2 and right and left rSO2 were assessed at seven-time points: supine position without oxygen administration (T1), supine position with oxygen administration (T2-baseline), intubation in the supine position (T3), just after prone positioning (T4), 10 minutes after prone positioning (T5), at the end of surgery in the prone position (T6) and at the end of anaesthesia in the supine position (T7). PCO2, PO2 and Hb partial were also recorded at T3 and T7. Results: Demographic data, pre-oxygenation hemodynamic variables and rSO2 were comparable between the groups. There was no significant difference between groups in SAP, DAP, HR, SPO2, and ETCO2 (p=0.095, p=0.061, p=0.357, p=0.088, p=0.328 respectively). PCO2, PO2 and Hb were not significant different between groups (p=0.542, p=0.394, p=0.768 respectively). rSO2 values were not significantly different between groups. In the propofol group, right rSO2 was significantly higher at T3 (p=0.017) and significantly lower at T5 (p=0,019) and at T6 (p=0,028) compared to baseline. Left rSO2 decreased significantly from baseline at T5 (p=0.026) in the propofol group. Left and right rSO2 in the desflurane group decreased significantly from baseline at T5 (p=0.0004 and p=0.0115). Conclusion: In the prone position, desflurane and propofol were associated with a significant decrease in rSO2 without differences between these anaesthetics.

scholarly journals Standard Care Versus Awake Prone Position in Adult Nonintubated Patients With Acute Hypoxemic Respiratory Failure Secondary to COVID-19 Infection—A Multicenter Feasibility Randomized Controlled Trial

2021 ◽  
pp. 088506662110144
Author(s):  
Devachandran Jayakumar ◽  
Pratheema Ramachandran, DNB ◽  
Ebenezer Rabindrarajan, DNB ◽  
Bharath Kumar Tirupakuzhi Vijayaraghavan, MD ◽  
Nagarajan Ramakrishnan, AB ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Prone Position ◽  
Feasibility Study ◽  
Standard Care ◽  
Controlled Trial ◽  
Prone Positioning ◽  
Hypoxemic Respiratory Failure ◽  
Randomized Controlled ◽  
Significant Difference ◽  
Hypoxic Respiratory Failure

Rationale: The feasibility and safety of awake prone positioning and its impact on outcomes in non-intubated patients with acute respiratory distress syndrome secondary to COVID-19 is unknown. Results of the observational studies published during this pandemic have been conflicting. In this context, we conducted a multi-center, parallel group, randomized controlled feasibility study on awake prone positioning in non-intubated patients with COVID-19 pneumonia requiring supplemental oxygen. Methods: 60 patients with acute hypoxic respiratory failure secondary to COVID-19 pneumonia requiring 4 or more liters of oxygen to maintain a saturation of ≥92% were recruited in this study. Thirty patients each were randomized to either standard care or awake prone group. Patients randomized to the prone group were encouraged to self-prone for at least 6 hours a day. The primary outcome was the proportion of patients adhering to the protocol in each group. Results: In the prone group, 43% (13 out of 30) of patients were able to self-prone for 6 or more hours a day. In the supine group, 47% (14 out of 30) were completely supine and 53% spent some hours in the prone position, but none exceeded 6 hours. There was no significant difference in any of the secondary outcomes between the 2 groups and there were no adverse events. Conclusions: Awake prone positioning in non-intubated patients with acute hypoxic respiratory failure is feasible and safe under clinical trial conditions. The results of our feasibility study will potentially help in the design of larger definitive trials to address this key knowledge gap.

Influence of submaximal isometric contractions of the hamstrings on electromyography activity and force while functioning as hip extensors

2020 ◽  
pp. 1-8
Author(s):  
Dasom Oh ◽  
Wootaek Lim
Keyword(s):  
Prone Position ◽  
Supine Position ◽  
Isometric Contraction ◽  
Muscle Length ◽  
Biceps Femoris ◽  
Emg Activity ◽  
Isometric Contractions ◽  
Significant Difference ◽  
Extension Force ◽  
Long Head

BACKGROUND: Although the medial and lateral hamstrings are clearly distinct anatomically and have different functions in the transverse plane, they are often considered as one muscle during rehabilitation. OBJECTIVE: The purpose of the study was to compare the electromyographic (EMG) activity between the prone position and the supine position during maximal isometric contraction and to additionally confirm the effect of submaximal isometric contractions on EMG activity of medial and lateral hamstrings, and force. METHODS: In the prone position, EMG activities of the long head of biceps femoris (BFLH) and semitendinosus (ST) were measured during the maximal isometric contraction. In the supine position, hip extension force with EMG activity were measured during the maximal and the submaximal isometric contractions. RESULTS: EMG activity in the prone position was significantly decreased in the supine position. In the supine position, there was a significant difference between the BFLH and ST during the maximal isometric contraction, but not during the submaximal isometric contractions. CONCLUSIONS: The dependence on the hamstrings could be relatively lower during hip extensions. When the medial and lateral hamstrings are considered separately, the lateral hamstrings may show a more active response, with increased muscle length, in clinical practice.

scholarly journals High-Flow Nasal Cannula and Prone Positioning in Awake Patients with COVID-19 Related Respiratory Failure: An Observational Study.

2021 ◽  
Author(s):  
Fekri Abroug ◽  
Zeineb Hammouda ◽  
Manel Lahmar ◽  
Wiem Nouira ◽  
Syrine Maatouk ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Observational Study ◽  
Prone Position ◽  
Supine Position ◽  
Early Response ◽  
High Flow ◽  
Nasal Cannula ◽  
Youden Index ◽  
Prone Positioning ◽  
High Flow Nasal Cannula

Abstract Background: We report an observational study on the use of High-flow nasal cannula (HFNC) and awake prone position in patients with Covid-19 related severe ARF.Methods: chart analysis of consecutive patients with confirmed Covid-19 and severe ARF (PaO2/FiO2 ratio <150) who received HFNC. Patients were systematically encouraged to lie in the prone position if tolerated. We calculated initial ROX index (the ratio of SpO2/FIO2 to respiratory rate) while in supine position and at the end of the first HFNC session whether in prone or supine position, and their difference (delta ROX). The success/failure of HFNC (need for intubation) was recorded. Predictors of HFNC failure were identified using ROC curve and logistic regression.Results: HFNC was administered to 213 out of 360 patients with COVID-19 related severe ARF (71% male, median age:59 years (IQR:50-68), median PaO2/FIO2: 104(73-143). At the start of HFNC, median ROX index was 4(3.4-5). Among included patients, 178 (83.5%) could tolerate prone position and had a median of 4.4(2-6) prone sessions during a median of 10(4-16) hours/day each, for a median of 4(2-7) days. Overall, HFNC failure occurred in 61 patients (28.1%) with similar proportions in patients who had HFNC in prone position and in patients who did not tolerate prone position (29% and 26%, respectively; relative risk:1.14. 95%CI:0.62-2.1). In the prediction of HFNC outcome, AUC was highest for delta ROX (AUC=0.83); AUC for baseline ROX (0.71), PaO2/FiO2 (0.73), and SpO2 (0.67), were significantly lower. The delta ROX cut-off ≤1.8 had the best Youden index indicating the best combination of sensitivity (0.89) and specificity (0.61) with a PLR (2.33) and a NLR (0.17) to predict HFNC failure. Logistic regression disclosed the following predictors of HFNC failure: delta ROX: RR=0.44, 95%CI=0.32-0.62; p-0.0001); baseline ROX index: RR=0.58, 95% CI:0.39-0.85, p=0.005); SOFA score (RR=1.6 for each point; 95%CI: 1.1-2.2, p=0.007); and PaO2/FiO2 at admission: RR=0.96, 95%CI=0.94-0.99). Prone position was not related to HFNC success.CONCLUSION: Awake HFNC in prone position is feasible in most patients with severe hypoxemic COVID-19. Indicators of ARF severity and the early response to HFNC, rather than prone position are independently associated with HFNC outcome.

Additive Effect of Nitric Oxide Inhalation on the Oxygenation Benefit of the Prone Position in the Adult Respiratory Distress Syndrome 

1998 ◽  
Vol 89 (6) ◽  
pp. 1401-1406 ◽  
Author(s):  
Peter Germann ◽  
Gerald Poschl ◽  
Christian Leitner ◽  
Georg Urak ◽  
Roman Ullrich ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Adult Respiratory Distress Syndrome ◽  
Prone Position ◽  
Supine Position ◽  
Distress Syndrome ◽  
Lung Injury Score ◽  
Prone Positioning ◽  
Nitric Oxide Inhalation

Background The response to inhaled nitric oxide and prone positioning was investigated in 47 patients with adult respiratory distress syndrome to test the hypothesis that inhalation of nitric oxide when in the prone position would result in additive improvement in oxygenation. Methods The authors prospectively studied patients of both genders who were 15 to 75 yr old and had adult respiratory distress syndrome confirmed by computed tomography (lung injury score, 3.1+/-1). Results Compared with baseline values in the supine position (T1), inhalation of 10 ppm nitric oxide for 1 h (T2) decreased the mean pulmonary artery pressure from 33+/-9 mmHg to 28+/-6 mmHg (P &lt; 0.05; T2 vs. T1) and increased the ratio of the partial pressure of oxygen in arterial blood (PaO2) to inspired oxygen concentration (FiO2) from 115 (median first quartile [Q1] 97, median third quartile [Q3] 137) to 148 (Q1 132, Q3 196) (P &lt; 0.05; T2 vs. T1). Cessation of nitric oxide brought the values back to baseline (T3). Two hours of prone positioning (T4) significantly increased the PaO2:FiO2 ratio (T4 vs. T3). However, after an additional hour of nitric oxide inhalation in the prone position (T5), a significant decrease of the venous admixture (from 33+/-6% to 25+/-6%; P &lt; 0.05) and an increase of the PaO2:FiO2 ratio (from 165 [Q1 129, Q3 216] to 199 [Q1 178, Q3 316] [P &lt; 0.05; T5 vs. T4]) were observed. Conclusions In patients with isolated severe adult respiratory distress syndrome, inhalation of nitric oxide in the prone position significantly improved oxygenation compared with nitric oxide inhalation in the supine position or in the prone position without nitric oxide. The combination of the prone position with nitric oxide inhalation in the treatment of severe adult respiratory distress syndrome should be considered.

Effect of position on the mechanical interaction between the rib cage and abdomen in preterm infants

1992 ◽  
Vol 72 (3) ◽  
pp. 1032-1038 ◽  
Author(s):  
M. R. Wolfson ◽  
J. S. Greenspan ◽  
K. S. Deoras ◽  
J. L. Allen ◽  
T. H. Shaffer
Keyword(s):  
Pulmonary Function ◽  
Chest Wall ◽  
Preterm Infants ◽  
Prone Position ◽  
Phase Angle ◽  
Supine Position ◽  
Pulmonary Mechanics ◽  
Rib Cage ◽  
Lissajous Figures ◽  
Significant Difference

To determine the influence of body position on chest wall and pulmonary function, we studied the ventilatory, pulmonary mechanics, and thoracoabdominal motion profiles in 20 preterm infants recovering from respiratory disease who were positioned in both the supine and prone position. Thoracoabdominal motion was assessed from measurements of relative rib cage and abdominal movement and the calculated phase angle (an index of thoracoabdominal synchrony) of the rib and abdomen Lissajous figures. The ventilatory and pulmonary function profiles were assessed from simultaneous measurements of transpulmonary pressure, airflow, and tidal volume. The infants were studied in quiet sleep, and the order of positioning was randomized across patients. The results demonstrated no significant difference in ventilatory and pulmonary function measurements as a function of position. In contrast, there was a significant reduction (-49%) in the phase angle of the Lissajous figures and an increase (+66%) in rib cage motion in prone compared with the supine position. In addition, the degree of improvement in phase angle in the prone position was correlated to the severity of asynchrony in the supine position. We speculate that the improvement in thoracoabdominal synchrony in the prone position is related to alterations of chest wall mechanics and respiratory muscle tone mediated by a posturally related shift in the area of apposition of the diaphragm to the anterior inner rib cage wall and increase in passive tension of the muscles of the rib cage. This study suggests that the mechanical advantage associated with prone positioning may confer a useful alternative breathing pattern to the preterm infant in whom elevated respiratory work loads and respiratory musculoskeletal immaturity may predispose to respiratory failure.

scholarly journals Prone Versus Supine Position in Intubated COVID-19 Patients With ARDS: A Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Dita Aditianingsih ◽  
Adhrie Sugiarto ◽  
Sidharta Kusuma Manggala ◽  
Hansen Angkasa ◽  
Ahmad Pasha Natanegara
Keyword(s):  
Mechanical Ventilation ◽  
Mortality Rate ◽  
Partial Pressure ◽  
Prone Position ◽  
Supine Position ◽  
Meta Analysis ◽  
Arterial Oxygen ◽  
Icu Discharge ◽  
Significant Difference ◽  
Position Group

Abstract BackgroundThis review determined the effect of prone positioning in changes of partial pressure of arterial oxygen/fraction of inspired oxygen (PaO2/FiO2) ratio, partial pressure of carbon dioxide (PaCO2), mortality rate, ICU length of stay and duration of mechanical ventilation in intubated COVID-19 patients with severe ARDS.MethodsA computer-aided comprehensive electronic bibliographic search from MEDLINE, EMBASE, and Science Direct were conducted. The search comprised the articles written in English and intubated adults (≥ 18 years old) patients with COVID-19. The primary outcome was comparing PaO2/FiO2 ratio between prone and supine position group. Secondary outcomes were PaCO2, ICU discharge, and mortality rate. Review Manager version 5.4 (The Cochrane Collaboration) was used for statistical analyses of the included studies.ResultsA total of 7 articles were determined to be eligible, consisting of 1403 intubated COVID-19 patients with ARDS that showed prone position was associated with a higher PaO2/FiO2 ratio compared to supine position (MD 60.17, 95% CI 46.86 - 73.47; p < 0.00001). Four studies reported the PaCO2 measurement and showed no significant difference between prone and supine position (MD 2.07, 95% CI -2.79 - 6.92; p <0.40). Only two studies reported mortalities, one study had 262 deaths out of 648 patients (40.4%) and one study lost 11 out of 20 patients (55%). One study reported median ICU stay and mechanical ventilation duration (16 days) were significantly longer in prone position group.ConclusionThis meta-analysis showed that prone position improved PaO2/FiO2 ratio in intubated COVID-19 patients with ARDS.

scholarly journals How to improve the safety of bicortical pedicle screw insertion in the thoracolumbar vertebrae: Analysis base on three-dimensional CT reconstruction of patients in the prone position

2020 ◽  
Author(s):  
Chao Xu ◽  
Qingxian Hou ◽  
Yanchen Chu ◽  
Xiuling Huang ◽  
Wenjiu Yang ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Prone Position ◽  
Vertebral Body ◽  
Supine Position ◽  
Three Dimensional ◽  
Vena Cava ◽  
Ct Reconstruction ◽  
Screw Insertion ◽  
Pedicle Screw Insertion ◽  
Significant Difference

Abstract Background: Through the comparison of three-dimensional CT reconstruction between the supine position and the prone position, the relative position of thoracolumbar great vessels and vertebral body was studied, and the shortest safe distance between them was measured to improve the safety of bicortical pedicle screw insertion and reduce the risk of vascular injury. Methods: Forty adults were selected to participate the research. Three-dimensional reconstruction of thoracolumbar (T9-L3) CT was performed in the prone position and the supine position. The relative distance between the Aorta/Inferior Vena Cava (IVC) and vertebral body was obtained as AVD/VVD respectively. The relative angle of the Aorta/ IVC and the vertebral body was calculated as ∠AOY/∠VOY. Self-controlled experiments were carried out in the prone and the supine positions, and the data obtained were analyzed using SPSS 22.0 statistical software. Results: The AVD of the prone position and the supine position was the shortest at T12 (3.18 ±0.68mm), but the difference was not statistically significant. The aorta of the T9-L3 segment was shifted from the anterolateral to the anteromedial. The ∠AOY of the other groups differed significantly between the prone and supine positions in all vertebrae except L1 (P < 0.05), and the aorta in the prone position was more anteromedial than that of supine position. With regard to VVD/∠VOY, there was no significant difference between the prone and supine positions (P≥0.05), and the minimum VVD of L3 segment is greater than 5.4mm. The IVC has no obvious mobility and is fixed in the range of 20 °~ 30 ° near the midline. Conclusion: When using bicortical anchoring of pedicle screws, it is safe to ensure that the protruding tips of the screw is less than 3mm. Due to the mobility of the aorta in different postures and individual differences in anatomy, the prone position CT can help doctors to make better preoperative plans and decisions.

scholarly journals The Importance of Sex Differences on Outcome after Major Trauma: Clinical Outcome in Women Versus Men

2019 ◽  
Vol 8 (8) ◽  
pp. 1263
Author(s):  
Julian Joestl ◽  
Nikolaus W. Lang ◽  
Anne Kleiner ◽  
Patrick Platzer ◽  
Silke Aldrian
Keyword(s):  
Trauma Center ◽  
Major Trauma ◽  
Injury Severity ◽  
Demographic Data ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Hemodynamic Variables ◽  
Significant Difference ◽  
The Impact ◽  
Icu Treatment

Purpose: The purpose of this study was to evaluate epidemiological and clinically relevant sex-related differences in polytraumatized patients at a Level 1 Trauma Center. Methods: 646 adult patients (210 females and 436 males) who were classified as polytraumatized (at the point of admission) and treated at our Level I Trauma Center were reviewed and included in this study. Demographic data as well as mechanism of injury, injury severity, injury pattern, frequency of preclinical intubation, hemodynamic variables on admission, time of mechanical ventilation and of intensive care unit (ICU) treatment, as well as the incidence of acute respiratory distress syndrome (ARDS), multi organ failure (MOF), and mortality were extracted and analyzed. Results: A total of 210 female and 436 male patients formed the basis of this report. Females showed a higher mean age (44.6 vs. 38.3 years; p < 0.0001) than their male counterparts. Women were more likely to be injured as passengers or by suicidal falls whereas men were more likely to suffer trauma as motorcyclists. Following ICU treatment, female patients resided significantly longer at the casualty ward than men (27.1 days vs. 20.4 days, p = 0.013) although there was no significant difference regarding injury severity, hemodynamic variables on admission, and incidence of MOF, ARDS, and mortality. Conclusion: The positive correlation of higher age and longer in-hospital stay in female trauma victims seems to show women at risk for a prolonged in-hospital rehabilitation time. A better understanding of the impact of major trauma in women (but also men) will be an important component of efforts to improve trauma care and long-term outcome.

Axillary lymph node coverage of tangent radiotherapy: Comparison of supine versus prone positioning.

2012 ◽  
Vol 30 (27_suppl) ◽  
pp. 200-200 ◽  
Author(s):  
Gregory M. Thompson ◽  
Ruth F. Lavigne ◽  
Mark Dimascio ◽  
Carlos Bohorquez ◽  
Michael A. S. Lamba
Keyword(s):  
Lymph Node ◽  
Prone Position ◽  
Supine Position ◽  
Axillary Lymph Node ◽  
Local Therapy ◽  
Axillary Lymph ◽  
Prone Positioning ◽  
Breast Radiotherapy ◽  
Whole Breast Radiotherapy ◽  
Tangent Fields

200 Background: Recent randomized evidence has demonstrated low rates of axillary nodal failure in patients with one to two positive lymph nodes who receive local therapy with sentinel lymph node biopsy and simple tangential radiotherapy alone. Decreasing utilization of complete axillary nodal dissections has potential implications for radiotherapy treatment delivery design. We sought to compare the inadvertent coverage of the axillary lymph nodal regions between supine versus prone position for whole breast radiotherapy using simple tangent fields. Methods: Twenty patients with breast cancer who had previously received whole breast radiotherapy with simple tangent fields were randomly selected. Patients were selected such that 10 patients had received treatment in the supine position and 10 patients in the prone position. Axillary lymph node levels I-III were contoured by a single physician according to the RTOG breast contouring atlas. The previously generated radiotherapy plans, each to deliver a prescribed dose between 42.56 and 50Gy, were dosimetrically compared to assess differences in coverage of the nodal volumes. Results: In both positions, dose to each of the axillary nodal regions was low. For level I, the volume receiving 95% of the prescribed dose (V95) was 34.7% for supine positioning and 1.6% for prone positioning. All other analyzed volumes, specifically V25 (71.5% vs 32.6%), V50 (63.3% vs 28.2%), and V75 (57.6% vs 24.1%), were 50% greater for supine compared to prone positioning. Level II coverage was less with V95 of 6% and 0.1% respectively. Similarly V25 (32.8% vs 5.7%), V50 (25.7% vs 3.8%), and V75 (20.3% vs 2.1%) were less compared to level one and greater in the supine position. Level III coverage was less than 10% for both positions at all measured volumes of V95, V75, V50, and V25. Conclusions: Delivery of radiotherapy using simple tangents inadequately covers all axillary nodal levels. Coverage is greater in the supine position with very little inadvertent coverage in the prone position. The risk of nodal recurrence should be carefully considered when deciding to use a simple tangential field design. Additional factors such as dose to the lung and heart should also be considered for positioning.

Sign in / Sign up

Export Citation Format

Share Document