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PubMedDate not supplied

[Gastroesophageal reflux and bronchial asthma: pH-metric patterns in non allergic children].

The presence of gastroesophageal reflux (GER) was studied, by computerized 24 hours intraesophageal pH monitoring, in 27 asthmatic children (16 M - 11 F; mean age 75.04 months) without allergy and in absence of medical treatment for at least ten days. Patient were divided in 3 groups: Group A (11 cases): subjects with Reflux Index (R.I. = percentage of time pH < 4) more than 4.2% and with GER percentage of time in standing position > supine position (p < 0.001). Group B (6 cases): subjects with R.I. more than 4.2% and with GER percentage of time in standing position < supine position (p = 0.05). Group C (10 cases): subjects with R.I. less than 4.2%. A group D (10 cases): normal children considered as control. The group A ("daily refluxes") resulted as the most numerous, in contrast to the studies up to now followed. The total number of refluxes resulted with no significant difference in groups A, B and C, but a significant prevalence of this number was noted in the group C against group D. Therefore, the parameter "Total number of refluxes in 24 hours" characterizes in our opinion, on the pH monitoring, children with bronchial asthma and without allergy.

Adolescent↗
PubMed2002

Situational factors affecting sleep paralysis and associated hallucinations: position and timing effects.

Sleep paralysis (SP) entails a period of paralysis upon waking or falling asleep and is often accompanied by terrifying hallucinations. Two situational conditions for sleep paralysis, body position (supine, prone, and left or right lateral decubitus) and timing (beginning, middle, or end of sleep), were investigated in two studies involving 6730 subjects, including 4699 SP experients. A greater number of individuals reported SP in the supine position than all other positions combined. The supine position was also 3-4 times more common during SP than when normally falling asleep. The supine position during SP was reported to be more prevalent at the middle and end of sleep than at the beginning suggesting that the SP episodes at the later times might arise from brief microarousals during REM, possibly induced by apnea. Reported frequency of SP was also greater among those consistently reporting episodes at the beginning and middle of sleep than among those reporting episodes when waking up at the end of sleep. The effects of position and timing of SP on the nature of hallucinations that accompany SP were also examined. Modest effects were found for SP timing, but not body position, and the reported intensity of hallucinations and fear during SP. Thus, body position and timing of SP episodes appear to affect both the incidence and, to a lesser extent, the quality of the SP experience.

Adult↗
PubMedDate not supplied

[Reverse Trendelenburg's position vs. supine-horizontal position for induction of general anesthesia in obese neurosurgical patients].

INTRODUCTION: The induction of general endotracheal anesthesia (GETA) is associated with variable period of apnea. Obese patients have reduced oxygen supply during period of apnea. Hypoxemia and subsequent hypercarbia, during period of apnea, are strong stimuli of cerebral blood flow and intracranial pressure increase. OBJECTIVE: The objective of our study was to determine the patient position with safe apnea period (SAP), which will minimize the risk of hypoxemia, as an optimal positioning for induction of GETA in obese neurosurgical patients. METHOD: Obese patients (BMI > 30kg m(-2)) were randomly placed to one of two positions for induction of GETA: group I (n=20) consisted of patients assuming 30 degree reverse Trendelenburg's position; group II (n=20) was in supine-horizontal position. After the arterial oxygen saturation of 100% measured by pulse oximetry (SpO2), patients were allowed to remain apneic. The time required for SpO2 to decline from 100% to 94% was recorded as SAP. The lowest SpO2 after restoration of ventilation and recovery time to 98% SpO2 were also recorded. RESULTS Time needed for SpO2 to decline to 94% was: 196.9 +/- 21.53 sec in group I, and 130.65 +/- 25.73 sec in group II. There was significant difference between groups (I vs. II; p < 0.05). SpO2 of patients in the reverse Trendelenburg's position dropped the least and took the shortest time to restore to 98%. The recovery time was much longer in group II, 132.65 +/- 33.75 (I vs. II; p < 0.05). CONCLUSION: 30 degree reverse Trendelenburg's position provides longer SAP when compared with horizontal-supine positions. This extra time may preclude adverse sequelae resulting from hypoxemia during induction of obese neurosurgical patients.

Anesthesia, General↗
PubMed1999

Preservation of postural control of transient lower oesophageal sphincter relaxations in patients with reflux oesophagitis.

INTRODUCTION: In normal subjects, transient lower oesophageal sphincter relaxations (TLOSRs) and gas reflux during belching are suppressed in the supine position. Supine reflux, however, is a feature of reflux disease. AIMS: To investigate whether postural suppression of TLOSRs and gas reflux is impaired in patients with reflux disease. PATIENTS: Ten patients with erosive oesophagitis. METHODS: Oesophageal manometry was performed during gastric distension with 750 ml carbon dioxide. Measurements were made for 10 minutes before and after distension in both sitting and supine positions. RESULTS: In the sitting position gastric distension substantially increased the rate of gas reflux (median (interquartile range)), as evidenced by increases in oesophageal common cavities from 1 (0-1)/10 min to 7 (5-10)/10 min and TLOSRs from 1 (1-1.5)/10 min to 6 (2.5-8)/10 min. However, this effect was suppressed in the supine position in all but one patient (TLOSRs 0 (0)/10 min to 1 (0-4.5)/10 min, common cavities 0 (0)/10 min to 0.5 (0-2)/10 min). CONCLUSIONS: Postural suppression of TLOSRs and gas reflux is generally preserved in reflux disease.

Adult↗
PubMed1983

Dural sinus pressure as related to neurosurgical positions.

Taking advantage of the exposure of dural sinuses during craniotomies, we measured confluens sinuum pressure by direct catheterization. The influence of various surgical positions and of other factors on confluens sinuum pressure was studied. When the upper half of the body was raised, the confluens sinuum pressure decreased to reach zero at +25 degrees; when the angle was +90 degrees, a marked negative pressure of -12.7 +/- 3.0 cm H2O (mean +/- SD) was observed in adults. In children under 6 years of age, however, such negative pressure was not observed even at an angle of +90 degrees. The confluens sinuum pressure was 2.7 +/- 0.6 cm H2O with the patient in the reverse jackknife position (supine position with the upper and lower halves of the body elevated ca. 20 degrees), 3.0 +/- 0.8 in the sea lion position (prone position with the upper and lower halves of the body elevated ca. 20 degrees and with the neck hyperextended), 5.8 +/- 0.9 in the prone position, and 5.9 +/- 1.7 in the supine position. In the supine and the sitting positions, the confluens sinuum pressure was elevated well enough by jugular compression to prevent air embolism. Positive pressure respiration did not raise the confluens sinuum pressure. The pressure of the jugular bulb measured by percutaneous direct puncture did not always reflect the confluens sinuum pressure, probably because subcutaneous hematoma produced an effect similar to that of jugular compression.

Adolescent↗
PubMed1983

[The significance of dural sinus pressure in neurological surgery-- correlation with surgical position].

A study was made of the significance of confluens sinus pressure in various surgical positions and of various factors influencing confluens sinus pressure. The following findings were obtained: Confluens sinus pressure in various positions was follows: Reverse jackknife position (supine position with upper and lower halves of the body elevated ca 20 degrees) 1.3 +/- 0.8 (Mean +/- SD) cmH2O Sea lion position (prone position with upper and lower halves of the body elevated ca 10 degrees with neck hyperextended) 2.7 +/- 0.6 cmH2O Prone position 5.8 +/- 0.9 cmH2O Supine position 5.9 +/- 1.7 cmH2O Right lateral position 6.9 +/- 0.7 cmH2O Left lateral position 9.6 +/- 1.2 cmH2O Since confluens sinus pressure is strongly affected by gravity, the determination point, the height of the right atrium, and the central venous pressure were referred to when measuring the surgical position. When the upper half of the body was raised (at angle ranging from--10 degrees to +90 degrees) confluens sinus pressure became zero in adults when the angle was +25 degrees or thereabouts. When the angle was +90 degrees, a marked negative pressure of -12.7 +/- 3.0 cmH2O, was observed, suggesting the danger of air embolism. In 4 children under 6 years of ago, however, negative pressure was not observed even at an angle of +90 degrees, although some changes due to different angles were noted. This suggests some specificity of dural sinus pressure. Intrathoracic negative pressure at inspiration, the contraction of skeletal muscles, and profuse hemorrhage, and sympathetic nervous strain were surmised as other factors influencing dural sinus pressure.

Adult↗
PubMedDate not supplied

[Effect of preterm infant position on weaning from mechanical ventilation].

OBJECTIVE: To determine the effects of prone positioning on cardiorespiratory stability and weaning outcome of preterm infants during weaning from mechanical ventilation. METHODS: From January to December 1999, a sample of 42 preterm infants, with birthweight < 2,000 g, mechanically ventilated in the first week of life, were randomly divided, in the beginning of the weaning process, into two groups according to the position: supine position (n = 21) or prone position (n = 21). Heart rate, respiratory rate, transcutaneous oxygen saturation and ventilatory parameters were recorded every one hour. Length of the weaning process and complications were also assessed. RESULTS: In both groups the mean gestational age was 29 weeks, most of the patients presented very low birthweight and respiratory distress syndrome. The mean length of the weaning process was 2 days. There were no differences between the groups regarding respiratory rate, heart rate and transcutaneous oxygen saturation, however, oxygen desaturation episodes were more frequent in supine position (p = 0.009). Ventilatory parameters decreased faster and reintubation was less frequent in the prone group (4% versus 33%). No adverse effects of prone positioning were observed. CONCLUSION: These results suggest that prone position is a safe and beneficial procedure during weaning from mechanical ventilation and may contribute to weaning success in preterm infants.

Female↗