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Effect of head rotation on cerebral blood velocity in the prone position.
MedLine Citation:
PMID:  22988456     Owner:  NLM     Status:  PubMed-not-MEDLINE    
Abstract/OtherAbstract:
Background. The prone position is applied to facilitate surgery of the back and to improve oxygenation in the respirator-treated patient. In particular, with positive pressure ventilation the prone position reduces venous return to the heart and in turn cardiac output (CO) with consequences for cerebral blood flow. We tested in healthy subjects the hypothesis that rotating the head in the prone position reduces cerebral blood flow. Methods. Mean arterial blood pressure (MAP), stroke volume (SV), and CO were determined, together with the middle cerebral artery mean blood velocity (MCA V(mean)) and jugular vein diameters bilaterally in 22 healthy subjects in the prone position with the head centered, respectively, rotated sideways, with and without positive pressure breathing (10 cmH(2)O). Results. The prone position reduced SV (by 5.4 ± 1.5%; P < 0.05) and CO (by 2.3 ± 1.9 %), and slightly increased MAP (from 78 ± 3 to 80 ± 2 mmHg) as well as bilateral jugular vein diameters, leaving MCA V(mean) unchanged. Positive pressure breathing in the prone position increased MAP (by 3.6 ± 0.8 mmHg) but further reduced SV and CO (by 9.3 ± 1.3 % and 7.2 ± 2.4 % below baseline) while MCA V(mean) was maintained. The head-rotated prone position with positive pressure breathing augmented MAP further (87 ± 2 mmHg) but not CO, narrowed both jugular vein diameters, and reduced MCA V(mean) (by 8.6 ± 3.2 %). Conclusion. During positive pressure breathing the prone position with sideways rotated head reduces MCA V(mean) ~10% in spite of an elevated MAP. Prone positioning with rotated head affects both CBF and cerebrovenous drainage indicating that optimal brain perfusion requires head centering.
Authors:
Jakob Højlund; Marie Sandmand; Morten Sonne; Teit Mantoni; Henrik L Jørgensen; Bo Belhage; Johannes J van Lieshout; Frank C Pott
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Publication Detail:
Type:  Journal Article     Date:  2012-09-05
Journal Detail:
Title:  Anesthesiology research and practice     Volume:  2012     ISSN:  1687-6970     ISO Abbreviation:  Anesthesiol Res Pract     Publication Date:  2012  
Date Detail:
Created Date:  2012-09-18     Completed Date:  2012-09-19     Revised Date:  2013-04-02    
Medline Journal Info:
Nlm Unique ID:  101532982     Medline TA:  Anesthesiol Res Pract     Country:  United States    
Other Details:
Languages:  eng     Pagination:  647258     Citation Subset:  -    
Affiliation:
Department of Anaesthesia, Sygehus Nord, 4300 Holbæk, Denmark.
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