Lyzohub Mykola*, Kotulskii Ihor, Lyzohub Kseniia, Moskalenko Nataliia and Pishchik Victoriia

SI “Sytenko Institute of Spine and Joint Pathology of National Academy of Medical Science of Ukraine”, Kharkiv, Ukraine

*Corresponding Author: Anna Kusturova, Assistant Professor, Researcher, Department of Orthopedics and Traumatology, State University of Medicine and Pharmacy “Nicolae Testemitanu”, Chisinau, Republic of Moldova.

Received: April 19, 2021; Published: May 06, 2021

Abstract

Introduction: A significant amount of surgeries, especially orthopedic, are provided in prone position. This position is accompanied by some physiologic changes, that may lead to complications during anesthesia and surgery. Postural hemodynamic reactions are well-known but their dependencies on anthropometrics are still not fully studied.

Aim: To study the influence of body mass index (BMI) and age on hemodynamics of patients after turning them from supine to prone position.

Materials and Methods: We examined 200 people with vertebrogenic pathology 18 - 75 yo; 118 male and 82 female. In group A there were people with BMI ≤ 25 kg/m² and in group B - people with BMI > 25 kg/m². Hemodynamics (blood pressure, peripheral vascular resistance, stroke volume) were examined by impedance thoracic rheography in supine position, in prone position 5 min after turning and in prone position 20 min after turning.

Results: It was shown that turning of the patient into prone position leads to statistically significant hemodynamic changes (P < 0.05). Peripheral vascular resistance increased by 13,4 ± 3,4% and stroke volume index (SVI) decreased by 14.8 ± 3.5%. These changes were mostly dependent from BMI. In patients with normal BMI, SVI decreased by 11,0 ± 3,0% 5 min after turning and in 20 min it returned to normal range. In obese patients SVI decreased by 18,3 ± 3,9% after turning and it did not return to normal range in 20 min.

Conclusion: Compensatory reactions of cardio-vascular system after turning to prone position depend on age and BMI. Dependence on BMI is more significant and anesthesiologist should be aware of these changes when planning anesthesia in prone position.

Keywords: Body Mass Index; Hemodynamics; Prone Position

References

1. Wu CY., et al. “Does targeted pre-load optimisation by stroke volume variation attenuate a reduction in cardiac output in the prone position”. Anaesthesia7 (2012): 760-764.
2. Kim D., et al. “Pulse pressure variation and pleth variability index as predictors of fluid responsiveness in patients undergoing spinal surgery in the prone position”. Therapeutics and Clinical Risk Management 14 (2018): 1175-1183.
3. Leslie K., et al. “Cardiac output and propofol concentrations in prone surgical patients”. Anaesthesia and Intensive Care 5 (2011): 868-874.
4. Lyzohub M., et al. “Anesthesia for surgery in prone position (article in Ukrainian)”. Orthopedics, Traumatology and Prosthetics 3 (2013): 99-106.
5. Kubicek WG., et al. “Development and evaluation of an impedance cardiac output system”. Aerospace Medicine 12 (1966): 1208-1212.
6. Shimizu M., et al. “Cardiac function changes with switching from the supine to prone position: analysis by quantitative semiconductor gated single-photon emission computed tomography”. Journal of Nuclear Cardiology 2 (2015): 301-307.