Lithotomy versus jack-knife position on haemodynamic parameters assessed by impedance cardiography during anorectal surgery under low dose spinal anaesthesia: a randomized controlled trialReport as inadecuate




Lithotomy versus jack-knife position on haemodynamic parameters assessed by impedance cardiography during anorectal surgery under low dose spinal anaesthesia: a randomized controlled trial - Download this document for free, or read online. Document in PDF available to download.

BMC Anesthesiology

, 15:74

Perioperative medicine and outcome

Abstract

BackgroundAlthough the prone position providing better exposure for anorectal surgery is required it can cause a reduction of cardiac output and cardiac index.
The goal was to compare haemodynamic changes assessed by impedance cardiography during anorectal surgery under low-dose spinal anaesthesia in lithotomy and jack-knife position.

MethodsThe prospective randomized controlled study included 104, ASA I-II adult patients admitted for elective minor anorectal surgery, assigned to be performed in lithotomy groupL, n = 52 or jack-knife position groupJ, n = 52.
After arrival to operating room the standard monitoring, impedance cardiography device was connected to the patient, and the following variables were recorded: cardiac output, cardiac index, systemic vascular resistance, stroke index at times of arrival to operating room, placement for, start and end of surgery and placement to bed.
Spinal block was made in the sitting position with 4 mg of 0.5% hyperbaric bupivacaine and 10 μg of Fentanyl injected over 2 min.
Comparison was based on haemodynamic changes between and inside groups over time.
Student’s t, chi square tests were used for statistical analysis with p < 0.05 regarded as statistically significant.

ResultsThe reduction of cardiac output was statistically significant after placement of the patient into the prone position: from baseline 7.4+-−1.6 to 4.9+-−1.2 after placement for and 4.7+-−1.2 at the start and end of surgery mean +-−SD l-min.
The difference of cardiac output between groups was 2.0 l-min after positioning for and the start of surgery and 1.5 l-min at the end of surgery p < 0.05.
Mean cardiac index reduced from baseline 3.9+-−0.8 to 2.6+-−0.7 and 2.4+-−0.6 mean+-−SD l-min-m in groupJ and between groups: by 1.0 l-min-m after placement for, 1.1 at the start and 0.8 at the end of surgery p < 0.05.
Systemic vascular resistance increased from baseline 1080+-−338 to 1483+-−479 after placement for, 1523+-−481 at the start and 1525+-−545 at the end of surgery in groupJ mean+-−SD dynes-sec-cm, p < 0.05.

ConclusionsAccording to impedance cardiography, jack-knife position after low-dose spinal anaesthesia produces transitory, but statistically significant reduction of cardiac output and cardiac index with increase of systemic vascular resistance, compared to insignificant changes in lithotomy position.

Trial registrationClinical Trials NCT02115178.

KeywordsSpinal anaesthesia Haemodynamic parameters Cardiac output Impedance cardiography Prone position AbbreviationsICGImpedance cardiography

COCardiac output

CICardiac index

SVRSystemic vascular resistance

SIStroke index

ACIAcceleration index

OROperating room

HRHeart rate

BMIBody mass index

bpmBeats per minute

MAPMean arterial blood pressure

Group JJack-knife group

Group LLithotomy group

TEETransoesophageal dopller

TIVATotal intravenous anaesthesia

IVIntravenous

TEBTransthoracic electric bioimpedance

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Author: Jurgita Borodiciene - Jurate Gudaityte - Andrius Macas

Source: https://link.springer.com/



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