The Effect of Patient Positioning on Intraabdominal Pressure and Blood Loss in Spinal Surgery

Park, Chang Kil

doi:10.1097/00000539-200009000-00009

Cited by 59 publications

(46 citation statements)

References 9 publications

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“…Correlations have been seen between elevated IAP and prone position with spine surgery. 7,14,20 Three of 4 patients experiencing abdominal complications in this series were obese. With obese patients, the IAP is elevated compared with those with a normal BMI.…”

Section: Discussionmentioning

confidence: 75%

Abdominal complications following posterior spinal fusion in patients with previous abdominal surgeries

Shih¹,

Slimack²,

Roy³

et al. 2011

FOC

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Perioperative abdominal complications associated with spine surgery are rare. Although most known abdominal complications occur in conjunction with anterior spinal fusions, there is a paucity of reports reviewing abdominal complications occurring with posterior spinal fusions. The authors review 4 patients who experienced a perioperative abdominal complication following a posterior spinal fusion. In each of these patients, a history of abdominal surgery is present. Given the physiological changes that occur with surgery in the prone position, patients with previous abdominal surgeries are at risk for developing abdominal complications in the perioperative period.

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Section: Discussionmentioning

confidence: 75%

Abdominal complications following posterior spinal fusion in patients with previous abdominal surgeries

Shih¹,

Slimack²,

Roy³

et al. 2011

FOC

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“…Unlike many volatile anesthetics that are in clinical use, intravenous anesthetics (such as barbiturate, ketamine, propofol) have a highly limited passage from the placenta and therefore have wide safety margins [13,14]. Current anesthetic devices and developments in preoperative monitoring of the systemic functions of the pregnant patient and fetus have rendered surgical interventions in pregnancy safer [13][14][15][16]. Therefore, many authors have stated that the use of general anesthesia with appropriate anesthetic agents and methods has no ill effects [13,16] However, many surgeons and anesthetists prefer epidural or spinal anesthesia for cases of shorter operative duration, and general anesthesia only in longer cases [1,5].…”

Section: Discussionmentioning

confidence: 99%

“…In the Relton-Hall frame spinal surgical Table 1, the abdominal area and sternum are under no pressure in the four-poster spinal frame system, as the patient is prone and the abdomen is supported from the iliac crests and lateral pelvis and from the lateral chest area [4][5][6]14]. The Wilson frame spine surgical systems are similar [15]. Difficulties arise for the lateral position in the traditional micro-discectomy approach.…”

Section: Discussionmentioning

confidence: 99%

Recurrent Lumbar Disc Herniation in Pregnant Patient: A Case Report

Yuvruk¹

2015

J Spine

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“…18 The most important factor influencing the intra operative bleeding in spine surgeries is the incorrect positioning of the patient. 1 Pressure on the abdominal contents would be transmitted to the inferior vena cava, and then, to the epidural venous system, thus causing increased bleeding. 20 Maintaining normothermia reduces blood loss.…”

Section: Groupsmentioning

confidence: 99%

“…This event can also be attributed to the other reasons like prone position and increased intraabdominal pressure. 1 No investigations beyond physical examination and history taking were done to rule out other complications. The primary concern when administering an antifibrinolytic drug is the potential increased incidence of thromboembolic events.…”

Section: Groupsmentioning

confidence: 99%

Does Tranexemic Acid Reduce Blo O D Transfusion Requirements Perioperatively in Patients Undergoing Spine Stabilization Surgeries? A Prospective Randomized Double Blinded Controlled Study

Pradeep¹,

B²,

Ali³

2014

jemds

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. "Does tranexemic acid reduce blood transfusion requirements perioperatively in patients undergoing spine stabilization surgeries? A prospective randomized double blinded controlled study". Journal of Evolution of Medical and Dental Sciences 2014; Vol. 3, Issue 66, December 01; Page: 14314-14322, DOI: 10.14260/jemds/2014/3920 ABSTRACT: BACKGROUND: Spine surgeries may involve uncontrolled bleeding, resulting primarily from large vein and persists even after the wound is closed. Proper patient positioning, use of hypotensive anaesthesia regimen and normothermia reduces blood loss, additional measures to reduce bleeding & transfusion requirement must be considered in spine surgery. MATERIALS AND METHODS: Forty patients of both sexes between the age group 21 to 60 years belonging to ASA I to III who were scheduled for spine stabilization surgeries was enrolled for the study were randomized into two groups with 20 in each. Anaesthetic technique was standardized. Group T received Tranexamic acid bolus of 10 mg/kg i.v. over 15 min. after patient positioning followed maintenance infusion of 1mg/kg/hr. And Group N Equivalent volume of Normal saline. Intra-operative blood losses was measured by weighing sponges, measuring suction drainage and estimates of blood loss on the surgical drapes and gowns by the attending anesthesiologist. Post-operative blood losses were assessed by measuring wound drainage until drains withdrawal. Investigations like Hb, Platelet, PT and APTT were done pre and post-operatively. Patients were assessed postoperatively daily for any clinical evidence of deep venous thrombosis. RESULTS: Pre-operative haemoglobin in group T and N were 13.56±1.171 and 12.98±1.488 gm% respectively. Post-operative haemoglobin in group T and N were 11.97±1.351 and 11.07±1.044 gm% respectively. There was a statistically significant drop in haemoglobin in control group post operatively. (p=0.024)Mean intra-operative blood loss in group T was 1042.65 ± 147.535 ml and in group N 1149.25 ± 157.85 ml. Control group had higher intraoperative blood loss compared to Tranexamic acid group, which was statistically significant. (p=0.033).There was no difference in mean drop in haemoglobin, mean number of units of blood transfusion among study groups. CONCLUSION: Tranexamic acid in bolusdosage of 10 mg/kg i.v. over 15 min. after patient positioning followed maintenance infusion of 1mg/kg/hr significantly decreases intra-operative blood loss, thereby decreasing the requirement of intraoperative blood transfusion. However it does not have any major impact on post-operative blood loss. No thrombotic complications or other adverse events were noted in this study.

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The Effect of Patient Positioning on Intraabdominal Pressure and Blood Loss in Spinal Surgery

Abstract: The relationship of intraabdominal pressure changes to blood loss were examined with a rectal balloon pressure catheter during spinal surgery. Blood loss tended to increase with an increase in intraabdominal pressure in the narrow pad support width of the Wilson frame.

Cited by 59 publications

References 9 publications

Abdominal complications following posterior spinal fusion in patients with previous abdominal surgeries

Abdominal complications following posterior spinal fusion in patients with previous abdominal surgeries

Recurrent Lumbar Disc Herniation in Pregnant Patient: A Case Report

Does Tranexemic Acid Reduce Blo O D Transfusion Requirements Perioperatively in Patients Undergoing Spine Stabilization Surgeries? A Prospective Randomized Double Blinded Controlled Study

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