Prone Position
Conditions
Keywords
Prone position, Intra-abdominal pressure, Respiratory system compliance, Jackson table, Wilson frame, Chest roll
Brief summary
Increased intra-abdominal pressure(IAP) might influence on perioperative morbidity related to increased CVP, PVWP, SVR, PAP and decreased venous return and cardiac output. Prone position has been known to increase IAP. In clinical field, various apparatuses has developed to minimize IAP elevation during prone position operation. In this study, we would compare the changes of IAP and respiratory system compliance according to positional apparatus in prone position.
Detailed description
In clinical field, Wison frame, chest rolls and Jackson table have been widely used for prone position surgery. Among those apparatus, Jackson table has padded supports under the chest and pelvis, so that the abdomen can hang freely and prevent the abdominal compression. By reducing abdominal and thoracic pressure, Jackson table would reduce blood loss, and less effects on pulmonary mechanics. But few studies has known to compare IAP with other positioning apparatus such as Wilson frame or chest roll.
Interventions
DEVICEJackson surgical table
After standard total intravenous anesthesia using propofol and remifentanil continous infusion, patients were turned to the prone position on a Jackson table with two padded supports on each side. The supports were positioned under the lateral chest and at the iliac crest.
DEVICEWilson frame
After standard total intravenous anesthesia using propofol and remifentanil continous infusion, patients were turned to the prone position on a Wilson frame. The supports were positioned vertically from shoulder to iliac crest.
DEVICEChest roll
After standard total intravenous anesthesia using propofol and remifentanil continous infusion, patients were turned to the prone position on a chest roll. The supports were positioned vertically from shoulder to iliac crest.
Sponsors
Seoul National University Hospital
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
20 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* Patients who are scheduled for prone positioned spinal surgery * ASA Physical Status Classification System class I or II
Exclusion criteria
* Patients who did not agree * BMI \> 30kg/m2 * Patients who did not insert urinary foley catheter * Patients who have COPD or emphysema * Patients who have severe spine deformities such as scoliosis
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| changes of Intraabdominal presure (IAP) | 5 minute after position change | Compare IAP changes from supine to prone according to the positional apparatus : Wilson frame, Chestrolls and Jackson table |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Changes of IAP and total respiratory system comliance (Crs) accoridng to PEEP change | 1min after PEEP change | Compare IAP and Crs according to PEEP changes in each group. PEEP applied 0,3,6 and 9 cm H2O and recoding was done at 1min after PEEP change. Total respiratory system compliance (Crs) = TV/(Pplat-PEEP) |
| changes of dead space ventilation after position change | 5 minute after prone position | After genearal anesthetic induction, arterial blood gas analyssis (ABGA)was done at supine position. And then the position was changed to prone. 5minutes after prone position change, ABGA repeated, and calculated the dead space ventilation at each point. Dead space ventilation (Vd/Vt) = \[PaCo2-PETCO2\]/PaCo2 Finally, we would compare changes of dead space ventilation after position change. |
| Hemodynamic change | 1min after PEEP change | Check the hemodynamic changes according to PEEP change : 0,3,6 and 9 cmH2O |
Other
| Measure | Time frame | Description |
|---|---|---|
| Estimated blood loss (EBL) | intraoperatively | Compare the EBL among the groups. |
Countries
South Korea
Contacts
Primary ContactHee Pyung Park, MD Phd
Backup ContactEugene Kim, MD
Outcome results
None listed