Document Detail


Blood flow in the lower limbs in the knee-chest position. Ultrasonographic study in unanaesthetised volunteers.
MedLine Citation:
PMID:  9038443     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The knee-chest position for lumbar spine surgery is favoured because decreased filling of the epidural veins is associated with reduced peroperative bleeding. However, the position may be unfavourable from a circulatory point of view. In the present study, non-invasive assessment of circulation in the lower limbs was performed in 21 unanaesthetised, healthy volunteers who were placed in the surgical knee-chest position. Measurements included blood flow velocity (colour Doppler ultrasonography), oscillotonometric arterial blood pressure from upper and lower limbs and pulse oximetry from a toe. There was a statistically significant reduction in the posterior tibial artery flow velocity, maximally 31.6%, when the subject was moved from the prone to the knee-chest position. An enlargement of the trunk-femoral angle at the hip did not improve arterial flow. In 10 of the 21 volunteers, no flow in the posterior tibial vein was detected in the knee-chest position. In spite of the deteriorated blood flow, pulse oximetry indicated sufficient capillary flow in the very periphery of the lower limb. The change from prone to knee-chest position resulted in an increase in arterial blood pressure of the upper limb; the increase in diastolic arterial pressure was statistically significant (p < 0.001). It is concluded that the surgical knee-chest position involves deterioration of both the arterial and venous flow of the lower limbs. This should be considered in patients undergoing surgery in this position and, in particular, in those at risk of developing cardiovascular complications.
Authors:
E Laakso; J Ahovuo; P H Rosenberg
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Anaesthesia     Volume:  51     ISSN:  0003-2409     ISO Abbreviation:  Anaesthesia     Publication Date:  1996 Dec 
Date Detail:
Created Date:  1997-03-07     Completed Date:  1997-03-07     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0370524     Medline TA:  Anaesthesia     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  1113-6     Citation Subset:  AIM; IM    
Affiliation:
Department of Anaesthesiology, Helsinki University Central Hospital, Töölö Hospital, Finland.
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MeSH Terms
Descriptor/Qualifier:
Adult
Blood Pressure / physiology
Humans
Knee
Leg / blood supply*
Lumbar Vertebrae / surgery*
Male
Middle Aged
Oxygen / blood
Posture / physiology*
Regional Blood Flow
Thorax
Tibial Arteries / ultrasonography
Ultrasonography, Doppler, Color
Chemical
Reg. No./Substance:
7782-44-7/Oxygen

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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