Document Detail


Effects of the knee-chest position on cardiac index and propofol requirements during bispectral index (BIS)-guided spine surgery.
MedLine Citation:
PMID:  18164579     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
INTRODUCTION: The knee-chest (KC) position is often used for spine surgery. It is considered to promote significant changes in venous return and cardiac output. However, the magnitude of these changes and their consequences on intraoperative haemodynamics and anaesthetic requirements remain to be determined. The goal of the present study was to determine the changes in cardiac index and propofol requirements of patients undergoing spine surgery in the KC position. METHODS: Twenty ASA 1-3 patients scheduled for elective spine surgery were included in the study. A radial artery catheter and an oesophageal Doppler probe were properly positioned after induction of anaesthesia. Anaesthesia consisted of bispectral index (BIS)-guided, plasma target-controlled, propofol-remifentanil anaesthesia. After positioning the patient KC, remifentanil target concentration was maintained throughout the case as in the supine position whilst propofol target concentration was adjusted to maintain BIS values between 40 and 50. Cardiac index, stroke volume, heart rate, end-tidal CO(2) (ETCO(2)), mean arterial pressure, peak and plateau airway pressures, BIS values and plasma target concentrations of propofol and remifentanil were compared 15 min after induction of anaesthesia (in the supine position) and 15 min after placing the patients KC. Data are expressed as mean+/-S.D. except for DeltaPP expressed as a number of patients with DeltaPP greater than 13%. RESULTS: Cardiac index, stroke volume, mean arterial pressure and propofol target concentration were significantly decreased from supine to KC position: 2.6+/-0.03 to 1.7+/-0.04 l/min/m(2), p<0.0001; 68+/-1.2 to 45+/-1 ml, p<0.0001; 83+/-1.2 to 76+/-1.4 mmHg, p<0.0001 and 3+/-0.06 to 2+/-0.05 microg/ml, p<0.0001, respectively. The number of patients with DeltaPP greater than 13% was zero in the supine position and 18 (90%) in the KC position (p<0.0001). CONCLUSION: Placing surgical patients in the KC position during BIS guided anaesthesia was associated with marked decrease in cardiac index and propofol requirements. These results suggest that monitoring intraoperative cardiac index via an oesophageal Doppler and depth of anaesthesia with the BIS may be useful in patients undergoing spine surgery in the KC position.
Authors:
L Bennarosh; C Peuch; J Cohen; C Dauzac; P Guigui; J Mantz; S Dahmani
Related Documents :
15703129 - Description of a technique for anaesthetizing pregnant ewes for fetal surgery.
9689269 - Effects of desflurane and propofol on arterial oxygenation during one-lung ventilation ...
1415969 - Thoracic electrical bioimpedance measurement of cardiac output and cardiovascular respo...
3976339 - Left ventricular function during anaesthesia induction and sternotomy in patients with ...
11429349 - The clinical and biochemical effects of propofol infusion with and without edta for mai...
1858989 - Left ventricular performance during propofol or methohexital anesthesia: isotopic and i...
8513009 - Blood gas analysis in dogs with pulmonary heartworm disease.
24749809 - Subfoveal choroidal thickness in patients with chronic heart failure analyzed by spectr...
3816259 - Weaning from mechanical ventilation: successful use of modified inspiratory resistive t...
Publication Detail:
Type:  Clinical Trial; Journal Article     Date:  2008-01-08
Journal Detail:
Title:  Annales françaises d'anesthèsie et de rèanimation     Volume:  27     ISSN:  1769-6623     ISO Abbreviation:  Ann Fr Anesth Reanim     Publication Date:  2008 Feb 
Date Detail:
Created Date:  2008-02-25     Completed Date:  2008-07-09     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8213275     Medline TA:  Ann Fr Anesth Reanim     Country:  France    
Other Details:
Languages:  eng     Pagination:  158.e1-5     Citation Subset:  IM    
Affiliation:
Department of anaesthesia, Beaujon university hospital, assistance publique des hôpitaux de Paris and Paris-7 university, 100, boulevard du Général-Leclerc, 92110 Clichy, France.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Aged
Anesthetics, Intravenous / administration & dosage*
Female
Hemodynamics*
Humans
Knee
Male
Middle Aged
Orthopedic Procedures / methods*
Posture
Propofol / administration & dosage*
Spine / surgery*
Surgical Procedures, Elective
Thorax
Chemical
Reg. No./Substance:
0/Anesthetics, Intravenous; 2078-54-8/Propofol

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


Previous Document:  The decrease of preoperative autologous transfusion in France has not been linked to an increase of ...
Next Document:  Characterization and antitumor activity of triethylene tetramine, a novel telomerase inhibitor.