Prone versus sitting position in neurosurgery – differences in patients’ hemodynamic management

• Published in: World neurosurgery 2017-01, Vol.97, p.261-266
• Main Authors: Luostarinen, Teemu, MD, PhD, Lindroos, Ann-Christine, MD, PhD, Niiya, T., MD, PhD, Silvasti-Lundell, M., MD, PhD, Schramko, Alexey, MD, PhD, Hernesniemi, Juha, MD, PhD, Randell, Tarja, MD, PhD, Niemi, Tomi, MD, PhD
• Format: Article
• Language: English
• Subjects: Adult; Aged; Blood Pressure - physiology; Disease Management; Female; Fluid administration; Fluid Therapy - methods; Hemodynamics; Hemodynamics - physiology; Humans; Male; Middle Aged; Neurosurgery; Neurosurgical Procedures - adverse effects; Neurosurgical Procedures - methods; Patient Positioning - adverse effects; Patient Positioning - methods; Prone position; Prone Position - physiology; Prospective Studies; Sitting position
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2016.10.005

Abstract Objective Neurosurgery in general anesthesia exposes patient to hemodynamic alternations both in prone and sitting position. As the comparison of the sitting and prone position in neurosurgery is scarce, we aimed to evaluate hemodynamic profile during stroke volume-directed fluid administration in patients undergoing neurosurgery either in sitting or prone position. Methods Thirty patients in prone and 28 in sitting position in two separate prospective trials were randomized to receive either Ringer’s Acetate (RAC) or hydroxyethyl starch (HES 130 kDa/0.4) for optimization of stroke volume. After combining data from these two trials the two-way analysis of variance was performed to compare patients’ hemodynamic profile between the two positions and to evaluate differences between RAC and HES consumption. Results To achieve comparable hemodynamics during surgery higher mean cumulative dose of RAC than HES was needed (679±390 ml vs 455±253 ml, respectively, p < 0.05). However, when fluid consumption was adjusted with weight, statistical difference was lost. Fluid administration did not differ between prone and sitting position. Mean arterial pressure was lower and cardiac index and stroke volume index was higher overtime when patient was in sitting position. Conclusions Sitting position does not require excess fluid treatment compared to prone position. HES is slightly more effective than RAC in achieving comparable hemodynamics, but 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 surgery positions.