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CC BY-NC-ND 4.0 · J Neuroanaesth Crit Care 2021; 08(02): 92-98
DOI: 10.1055/s-0040-1715709
Original Article

A Comparative Evaluation of the Effect of Prone Positioning Methods on Blood Loss and 
Intra-Abdominal Pressure in Obese Patients Undergoing Spinal Surgery

Sandeep Kundra
1   Department of Anesthesia, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
,
Hanish Bansal
2   Department of Neurosurgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
,
Vishnu Gupta
3   Department of Neurosurgery, Fortis Hospital, Ludhiana, Punjab, India
,
Rekha Gupta
4   Department of Anesthesia, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Sandeep Kaushal
5   Department of Pharmacology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
,
Anju Grewal
1   Department of Anesthesia, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
,
Ashwani K. Chaudhary
2   Department of Neurosurgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
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Abstract:

Background Improper prone positioning of obese patients for spine surgery can increase the intra-abdominal pressure (IAP), resulting in increased bleeding from epidural venous plexus. The choice of prone positioning frame can be an important determinant of the IAP.

Materials and Methods This prospective, randomized study was performed on obese patients (body mass index ≥ 30) scheduled for lumbar laminectomy. After administration of general anesthesia, patients were positioned prone either on Wilson’s frame (group W), or on horizontal bolsters (group H). IAP was recorded at three intervals: (1) in supine position, (2) 10 minutes after prone positioning, and (3) in prone position at the end of surgery. Intraoperative blood loss was measured quantitatively and assessed subjectively by the surgeon.

Results A total of 60 patients were enrolled with 30 patients in each group. IAP in supine position was similar in both groups. However, IAP 10 minutes after prone positioning was significantly higher at 11.44 ± 1.61 mm Hg in group W as compared to 9.56 ± 1.92 mm Hg in group H (p = 0.001). Similarly, IAP of 12.24 ± 1.45 mm Hg in group W, measured on completion of surgery was significantly higher than 
9.96 ± 2.35 mm Hg in group H (p = 0.001). Mean total blood loss of 440.40 ± 176.98 mL in group W was significantly higher than 317.20 ± 91.04 mL in group H (p = 0.003).

Conclusion Obese patients positioned prone on Wilson’s frame had significantly higher IAP and blood loss compared to patients positioned on horizontal bolsters.

Keywords

prone position - spinal fusion - spine surgery - intra-abdominal pressure - Wilson’s frame


Publication History

Article published online:
07 September 2020

© 2020. Indian Society of Neuroanaesthesiology and Critical Care. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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