Research Article

Comparison the Effect of Changing from the Supine to Lateral Position and Vice Versa on Plethysmographic Variability Index and Hemodynamic Values Assessed by Ultrasonic Cardiac Output Monitors in Patients Who Undergo Thoracotomy

Abstract

Background: The change in patients' positions has a bold effect on the ventilation and hemodynamic parameters during surgery. In this study, we evaluated the changes in hemodynamic and ventilator values resulting from conversions in the position of patients under the thoracotomy from supine to lateral position and vice versa, to determine the most favourable position with the best hemodynamic stability and ventilation conditions.
Methods: In this pre and that post interventional clinical trial, 50 patients scheduled for thoracotomy were included. Following general anesthesia induction and 5 minutes later, hemodynamic data before thoracotomy and after the surgical intervention was measured, the patient was placed in the supine position and all hemodynamic data were recorded. Then, the position of the patient was slightly changed to the lateral recumbent position. Then, at the end of the surgery, the position was changed to supine.
Results: Regarding the change in study indices (including HR, SBP, DBP, MAP, SVV, CO, and PVI), changes in supine to lateral status led to only a decrease in systolic blood pressure, diastolic blood pressure, and mean blood pressure and other indicators did not show a statistically significant change. Similarly, the change in the above indices by changing the lateral to the supine state was only an increase in systolic blood pressure, diastolic blood pressure, mean blood pressure, and other data remained unchanged.
Conclusion: Changing the position of patients during surgical thoracotomy from supine to lateral position or vice versa is associated only with significant changes in patient's blood pressure and has no significant effect on other ventilatory and cardiovascular parameters.

[1] Cannesson M, Delannoy B, Morand A, Rosamel P, Attof Y, Bastien O, et al. Does the Pleth variability index indicate the respiratory-induced variation in the plethysmogram and arterial pressure waveforms? Anesth Analg. 2008;106(4):1189-94.
[2] Forget P, Lois F, de Kock M. Goal-directed fluid management based on the pulse oximeter-derived pleth variability index reduces lactate levels and improves fluid management. Anesth Analg. 2010;111(4):910-4.
[3] Colquhoun DA, Roche AM. Oesophageal Doppler cardiac output monitoring: a longstanding tool with evolving indications and applications. Best Pract Res Clin Anaesthesiol. 2014; 28(4):353-62.
[4] Mowatt G, Houston G, Hernández R, de Verteuil R, Fraser C, Cuthbertson B, et al. Systematic review of the clinical effectiveness and cost-effectiveness of oesophageal Doppler monitoring in critically ill and high-risk surgical patients. Health Technol Assess. 2009;13(7):iii-iv, ix-xii, 1-95.
[5] Pillai P, McEleavy I, Gaughan M, Snowden C, Nesbitt I, Durkan G, et al. A double-blind randomized controlled clinical trial to assess the effect of Doppler optimized intraoperative fluid management on outcome following radical cystectomy. J Urol. 2011; 186(6):2201e6.
[6] Huntsman LL, Stewart DK, Barnes SR, Franklin SB, Colocousis JS, Hessel EA. Noninvasive Doppler determination of cardiac output in man. Clinical validation. Circulation. 1983;67(3):593e602.
[7] Fujise K1, Shingu K, Matsumoto S, Nagata A, Mikami O, Matsuda T. The effects of the lateral position on cardiopulmonary function during laparoscopic urological surgery. Anesth Analg. 1998; 87(4):925-30.
[8] Yokoyama M, Ueda W, Hirakawa M, Yamamoto H. Hemodynamic effect of the prone position during anesthesia. Acta Anaesthesiol Scand. 1991; 35(8):741-4.
[9] Doering L, Dracup K. Comparisons of cardiac output in supine and lateral positions. Nurs Res. 1988; 37(2):114-8.
[10] Wood F, Wolferth C. The tolerance of certain cardiac patients for various recumbent positions (trepopnea). Am J Med Sci. 1935; 193, 354–378.
[11] Fujita M, Miyamoto S, Tambara K, Budgell B. Trepopnea in patients with chronic heart failure. Int J Cardiol. 2002; 84(2-3):115-8.
[12] Bornscheuer A, Mahr KH, Bötel C, Goldmann R, Gnielinski M, Kirchner E. Cardiopulmonary effects of lying position in anesthetized and mechanically ventilated dogs. J Exp Anim Sci. 1996; 38(1):20-7.
[13] Nakao S, Come PC, Miller MJ, Momomura S, Sahagian P, Ransil BJ, et al. Effects of supine and lateral positions on cardiac output and intracardiac pressures: an experimental study. Circulation. 1986; 73(3):579-85.
[14] Siepe M, Rüegg DM, Giraud MN, Python J, Carrel T, Tevaearai HT. Effect of acute body positional changes on the hemodynamics of rats with and without myocardial infarction. Exp Physiol. 2005; 90(4):627-34.
[15] Channabasappa SM, Shankarnarayana P. A comparative study of hemodynamic changes between prone and supine emergence from anesthesia in lumbar disc surgery. Anesth Essays Res. 2013; 7(2):173-7.
[16] Alibeigi F, Hosseini M, Shabanian M, Shabanian A, Shabanian Gh. Comparison of hemodynamic changes, movement, duration of surgery, and pain between lateral and supine positions after spinal anesthesia in transurethral lithotripsy. J Renal Inj Prev. 2019; 8(1): 11-16.
[17] Mezidi M, Guérin C. Effects of patient positioning on respiratory mechanics in mechanically ventilated ICU patients. Ann Transl Med. 2018;6(19):384.
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IssueVol 8 No Supp. 1 (2022): Supplement 1 QRcode
SectionResearch Article(s)
Keywords
Clinical trial Stress responses Transversus abdominal plane block

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Mireskandari SM, Makarem J, Hedayati Emami K, Jafarzadeh A, Karvandian K, Samadi S, Eslami B, Movafegh A. Comparison the Effect of Changing from the Supine to Lateral Position and Vice Versa on Plethysmographic Variability Index and Hemodynamic Values Assessed by Ultrasonic Cardiac Output Monitors in Patients Who Undergo Thoracotomy. Arch Anesth & Crit Care. 2022;8(Supp. 1):354-357.