The effect of prone position on the respiratory mechanics, with and without bolsters in patients under general anaesthesia : A cross sectional observational study
试验速览
- 阶段
- 不适用
- 状态
- 尚未招募
- 发起方
- 入组人数
- 106
- 试验地点
- 1
- 主要终点
- Dynamic compliance of the respiratory system
研究概览
简要总结
When a patient is positioned in the prone posture under general anaesthesia, abdominal pressure exerts force on the internal organs, causing the diaphragm to shift towards the cephalad direction. Additionally, the weight of the trunk compresses the thoracic cavity, reducing the anterior-posterior chest diameter. These alterations in body mechanics lead to a 20-30 percent reduction in respiratory compliance and an increase in peak inspiratory pressure. Consequently, the observed rise in PIP during prone positioning is primarily attributed to the diminished respiratory compliance resulting from these mechanical factors.
In conditions of reduced pulmonary compliance, achieving adequate ventilation may necessitate the use of elevated airway pressures. These elevated pressures can compromise venous return to the heart, leading to a reduction in cardiac output and an elevation in systemic venous pressure. Increased venous pressure in the epidural venous plexus is a recognized contributor to excessive surgical bleeding. Furthermore, elevated spinal venous pressure can decrease spinal cord perfusion pressure, calculated as the difference between mean arterial pressure and spinal venous pressure, thereby increasing the risk of neurological complications.
To mitigate these variations, a bolster is traditionally placed beneath the chest and pelvis to reduce intra-abdominal pressure and its associated physiological alterations. Spine surgeons commonly employ these bolsters to achieve optimal patient positioning during spinal surgeries. However, in percutaneous nephrolithotomy procedures, urologists typically avoid the use of such supports, as they can obstruct surgical access to the targeted area
Thus, this study will compare the changes in Dynamic compliance of the respiratory systemin the prone position with and without bolsters. In addition, changes in Peak airway pressure, mean airway pressure, EtCO2, heart rate, mean arterial pressure and Oxygen saturation will also be studied.
研究设计
- 研究类型
- Observational
入排标准
- 年龄范围
- 20.00 Year(s) 至 60.00 Year(s)（—）
- 性别
- All
入选标准
- •Patients of age group 20 to 60 years, undergoing elective surgeries under general anaesthesia in the prone position.
- •Patients classified under American Society of Anaesthesiologists (ASA) 1 and 2 after thorough Pre-Anaesthetic evaluation.
排除标准
- •Patient refusal.
- •Pregnant women.
- •Patients with BMI of 30kg/m2 and more.
- •Patients undergoing emergency surgeries.
- •Patients with significant spinal deformities, scoliosis, lardosis, kyphosis, ankylosing spondylitis.
- •Post intubation Bronchospasm.
- •Patients with compromised Respiratory conditions.
- •Patients with Oropharyngeal or Facial Pathologies 9)Patients who are active smokers.
结局指标
主要结局
Dynamic compliance of the respiratory system
时间窗: 5 minutes after intubation, Prone, 15 minutes, 30 minutes, 60 minutes, 90 minutes, 120 minutes, 150 minutes, 180 minutes, After making supine
次要结局
- Peak airway pressure (P peak), mean airway pressure (P mean), end tidal CO2(EtCO2), heart rate (HR), mean arterial pressure (MAP) and oxygen saturation (SpO2)(5 minutes after intubation, Prone, 15 minutes, 30 minutes, 60 minutes, 90 minutes, 120 minutes, 150 minutes, 180 minutes, After making supine)
研究者
Dr Mahesh Chandra
Rajarajeswari Medical College And Hospital Bangalore