Neurosurgery in the sitting position: retrospective analysis of 692 adult and pediatric cases

Dilmen, Özlem Korkmaz; Akçıl, Eren Fatma; Türeci, Ercan; Tunalı, Yusuf; Bahar, Mois; Tanrıverdi, Taner; Aydın, Sabri; Yentür, Ercüment

doi:10.5137/1019-5149.jtn.4974-11.0

Cited by 5 publications

(4 citation statements)

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“…Before closing sterile surgical drapes, the patients should be carefully observed and checked. Dilmen et al [28] detected VAE in 20.4% of adults and 26.3% of children who were in the sitting position in 692 cases. They also suggested CVC to aspirate the venous air embolism.…”

Section: Discussionmentioning

confidence: 97%

Pediatric neuroanesthesia experiences: A single center retrospective cohort study

et al. 2023

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Background/Aim: Pediatric neuroanesthesia is a special field that requires significant experience and infrastructure because of anatomical, neurological, and pharmacological differences in the pediatric patient population. Although technological improvements provide more effective and safer neuroanesthesiological management, the principles of neuroanesthesia, neurocognitive development, and the effects of anesthetic agents on central nervous system development are well-known. The majority of pediatric neuroanesthesia articles in the literature are reviews; however, retrospective/prospective case series and controlled research are limited. In this retrospective cohort study, we aimed to contribute to the existing literature by reviewing and analyzing our single-center 10-year experiences and results addressing pediatric neuroanesthesia management. Methods: After ethical committee approval, anesthetic and surgical reports from 1165 pediatric neurosurgical cases over ten years were collected. Demographic data, intra-operative vascular management, anesthesia techniques, airway management, patient positions, analgesia methods, and complications were evaluated in this retrospective cohort study. The available surgical intervention, patient positions, intra-operative neuromonitorization (IONM), and intra-operative magnetic resonance imaging (IOMR) records were also analyzed. Results: Six-hundred forty-six (55.4%) girls and 519 (44.5%) boys were included in the study. The median age was 60 (0–216) months. Cranial interventions were performed in 842 (72.3%) patients, and spinal interventions were performed in 323 (27.7%) patients. Patients’ American Society of Anesthesiologists (ASA) physical scales grouped as I, II, III, and IV were 718 (61.6%), 360 (30.9%), 82 (7%), and 5 (0.4%), respectively. Sevoflurane (40.3%), propofol (37.2%), and sodium thiopental (2.5%) were used for anesthetic induction. Neuromuscular block was performed with rocuronium (56.7%) and atracurium (14.4%). Neuromuscular blocking agents were not used in 337 patients (28.9%). A blood transfusion was required in 120 patients (10.3%), and 40% of these patients underwent surgery for craniosynostosis. Two-hundred twenty-two (19.1%) were monitored with IONM, and IOMR was carried out in 124 (10.6%) of the cases. The anesthesia-related complication rate was 5.15% (60 patients). Conclusion: Although pediatric neurosurgical interventions involve high risks, they are becoming increasingly common in our daily practice. Neuroanesthesiologists should know the procedures, techniques, and advances for safe and effective management of pediatric neurosurgical cases. We think that these data may be helpful as a guide for the anesthetic management of pediatric neurosurgical cases.

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Section: Discussionmentioning

confidence: 97%

Pediatric neuroanesthesia experiences: A single center retrospective cohort study

et al. 2023

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“…The reason why this position is less used nowadays has to do with the increased risk of venous air embolism and hemodynamic instability. Dilmen et al [13] published a retrospective study in the year 2011 of 692 cases (601 adults and 92 children) operated in sitting position and concluded that venous air embolism, diagnosed using capnography, has an occurrence of 26.3% in children and 20.4% in adults and that position induced hypotension occurs more frequently in adult population (37,6%) compared to pediatric population (18,6%). They also concluded that patients suffering of chronic obstructive pulmonary disease tolerate with great difficulty venous air embolism and recommend not using the sitting position in these patients.…”

Section: Sitting Positionmentioning

confidence: 99%

“…Sitting position is a relative contraindication to patients that are diagnosed with patent foramen ovale because of the risk of paradoxical air embolism. Echocardiography is the screening method recommended to every patient that is a candidate for a neurosurgical intervention in sitting position [12,13].…”

Section: Sitting Positionmentioning

confidence: 99%

Patient Positioning in Neurosurgery, Principles and Complications

Bălaşa

Hurghiș²,

Tămaș³

et al. 2020

Acta Marisiensis - Seria Medica

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Patient positioning is a crucial step in neurosurgical interventions This is the responsibility of both the neurosurgeon and the anesthesiologist. Patient safety, surgeon’s comfort, choosing an optimal trajectory to the lesion, reducing brain tension by facilitating venous drainage, using gravitation to maintain the lesion exposed and dynamic retraction represent general rules for correct positioning. All bony prominences must be protected by silicone padding. The head can be positioned using a horseshoe headrest or three pin skull clamp, following the general principles: avoiding elevating the head above heart more than 30 degrees, avoiding turning the head to one side more than 30 degrees and maintaining 2 to 3 finger breaths between chin and sternum. Serious complications can occur if the patient is not properly positioned so this is why great care must be paid during this step of the surgical act.

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“…Therefore, it can be performed in a prone, sitting or semisitting position. [15][16][17][18][19][20][21][22][23][24][25][26] Although sitting or semisitting positions are frequently used in these operations, the risk of venous air embolism (VAE) is the most critical deterrent for surgeons and anesthesiologists. Many different methods have been developed to prevent, detect, and treat VAE, but these methods require a lot of experience, and when happening, their prognosis still remains poor.…”

mentioning

confidence: 99%

Dynamic Lateral Semisitting Position for Supracerebellar Approaches: Technical Note and Case Series

Durmuş,

Kaval,

Demirgil

et al. 2023

Operative Neurosurgery

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BACKGROUND: It has always been a matter of debate which position is ideal for the supracerebellar approach. The risk of venous air embolism (VAE) is the major deterrent for surgeons and anesthesiologists, despite the fact that sitting and semisitting positions are commonly used in these operations. OBJECTIVE: To demonstrate a reduction on the risk of VAE and tension pneumocephalus throughout the operation period while taking advantages of the semisitting position. METHODS: In this study, 11 patients with various diagnoses were operated in our department using the supracerebellar approach in the dynamic lateral semisitting position. We used end-tidal carbon dioxide and arterial blood pressure monitoring to detect venous air embolism. RESULTS: None of the patients had clinically significant VAE in this study. No tension pneumocephalus or major complications were observed. All the patients were extubated safely after surgery. CONCLUSION: The ideal position, with which to apply the supracerebellar approach, is still a challenge. In our study, we presented an alternative position that has advantages of the sitting and semisitting positions with a lower risk of venous air embolism.

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Neurosurgery in the sitting position: retrospective analysis of 692 adult and pediatric cases

Cited by 5 publications

References 0 publications

Pediatric neuroanesthesia experiences: A single center retrospective cohort study

Pediatric neuroanesthesia experiences: A single center retrospective cohort study

Patient Positioning in Neurosurgery, Principles and Complications

Dynamic Lateral Semisitting Position for Supracerebellar Approaches: Technical Note and Case Series

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