Anwendung der sitzenden Position in der Neurochirurgie

Schaffranietz, L; Grothe, A.; Olthoff, D

doi:10.1007/s001010050827

Cited by 28 publications

(1 citation statement)

References 18 publications

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“…[ 20 21 22 ] Many surgeons consider the presence of a PFO as an absolute contraindication to neurosurgery in the sitting position. [ 23 24 ] The incidence of detection of VAE varies depending upon the technique used. Transesophageal echocardiography and transthoracic Doppler echocardiography are sensitive techniques to detect as small as 0.02 ml/kg and 0.06 ml/kg, respectively.…”

Section: Discussionmentioning

confidence: 99%

Effects of Crystalloid Preloading (20 ml/kg) on Hemodynamics in Relation to Postural Changes in Patients Undergoing Neurosurgical Procedures in Sitting Position

Ranjith

Bidkar

Narmadalakshmi

et al. 2018

Journal of Neurosciences in Rural Practice

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Background:Hemodynamic disturbances are common during positioning the patients from supine to sitting for neurosurgical procedures. The reported incidence of hypotension varies from 5% to 32%. The aim of the study was to study the effect of crystalloid preloading on hemodynamic parameters during positioning the patient from supine to sitting position.Materials and Methods:In this prospective observational trial, 20 patients were enrolled. Two patients had a patent foramen ovale on transesophageal echocardiography and were excluded from the study. All the patients received 20 ml/kg of crystalloid (Ringer's lactate) before initiation of positioning. Physiological hemodynamic parameters such as heart rate, mean arterial pressure, central venous pressure, cardiac output (CO), stroke volume variation (SVV), cardiac index (CI), stroke volume (SV), and maximum and minimum inferior vena caval diameter (IVCD) were recorded after induction, during positioning at 30°, 60° inclination of the operating table and after the final sitting position.Results:Hemodynamic parameters were well maintained during positioning of the patients from supine to sitting position. Crystalloid preloading prevented the hypotension during positioning. There were no significant changes in hemodynamic parameters such as CO, SVR, SVV, CI, and SV. We did not find any correlation with changes in IVCD with changes in CO.Conclusion:A volume of 20 ml/kg of crystalloid preloading before positioning the patient from supine to sitting position maintains the hemodynamic stability and avoids the vasopressor requirement.

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Section: Discussionmentioning

confidence: 99%

Effects of Crystalloid Preloading (20 ml/kg) on Hemodynamics in Relation to Postural Changes in Patients Undergoing Neurosurgical Procedures in Sitting Position

Ranjith

Bidkar

Narmadalakshmi

et al. 2018

Journal of Neurosciences in Rural Practice

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Circulatory effects of internal jugular vein compression: A computer simulation study

Bošnjak

Kordaš

2002

Med. Biol. Eng. Comput.

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The effects of compression of the internal jugular veins and the inferior vena cava are simulated using an equivalent electronic circuit, which included simulation of cardiocirculatory phenomena and special features of the cerebral circulation. Compression of the inferior vena cava resulted in a profound decrease in cardiac output (from 4.5 to 1.51min(-1)) and arterial pressure (from 140/85 to 50/35 mmHg). Compression of the internal jugular veins resulted in a negligible decrease in cardiac output and arterial pressure, with a cerebral blood flow that was slightly decreased. Cerebral capillary and internal jugular pressures were considerably increased, leading to obstruction of cerebral veins and increased pressure (from 9 to 22 mmHg) and volume (from 120 to 145 ml) of the cerebrospinal fluid (CSF). Increased cerebral capsule compliance resulted in decreased CSF pressure (from 9 to 8.5 mmHg), but CSF volume increased (from 120 to 190 ml). A small increase in brain volume (from 1,000 ml to 1,060 ml, 6% volume increase) was compensated for by an equal decrease in the volume of CSF. When brain volume was above 1,080 ml, the absorption of CSF was reduced, and its pressure increased.

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The sitting position in neurosurgery: indications, complications and results. a single institution experience of 600 cases

Ganslandt

Merkel

et al. 2013

Acta Neurochir

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In our series, VAE was detected in 19 % of all patients in the sitting position. However, in only 0.5 % of cases a termination of the surgical procedure became necessary. In all other cases, the cause of air embolism could be found and eliminated during surgery. TEE was found to be the monitoring technique with the highest sensitivity. In our opinion, the sitting position is a safe positioning technique if TEE monitoring is used.

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Anwendung der sitzenden Position in der Neurochirurgie

Cited by 28 publications

References 18 publications

Effects of Crystalloid Preloading (20 ml/kg) on Hemodynamics in Relation to Postural Changes in Patients Undergoing Neurosurgical Procedures in Sitting Position

Effects of Crystalloid Preloading (20 ml/kg) on Hemodynamics in Relation to Postural Changes in Patients Undergoing Neurosurgical Procedures in Sitting Position

Circulatory effects of internal jugular vein compression: A computer simulation study

The sitting position in neurosurgery: indications, complications and results. a single institution experience of 600 cases

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