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At least 559 records · Page 31Linked to original sources

PubMed2002

[Anesthesia for a severe ankylosing spondylitis patient whose posture had been restricted to only sitting for over 20 years].

A 42-year-old woman with an Arnold-Chiari abnormality was scheduled for cervical spine surgery. She had severe ankylosing spondylitis, and all her joints from ankles to occipitocervical joint were fixed except hip joints, which had been replaced with artificial joints 20 years before. She could bend her upper body only in a range from -20 to 70 degree from the sitting position. Her posture had been restricted to only sitting for over 20 years, and she complained vertigo when positioned in supine position. The trachea was intubated with an aid of bronchofiberscopy under sedation in sitting position, and then anesthesia was induced with propofol and fentanyl. When she was turned to prone position, nasal bleeding was noticed and the surgery was performed in a modified sitting position. The intra- and post-operative course was uneventful. The present case indicates that long-term restriction only to sitting position modulates circulatory control in response to changing postures, and that preoperative evaluation for appropriate posture for surgery is mandatory.

Adult↗

PubMed2006

[Medullary tegmentum lesion in a patients having intractable hiccups, nausea, and syncope].

A 61-year-old female, having intractable hiccups, nausea, and syncope. Her systolic blood presure decreased by 30 mmHg on sitting position from supine position. Sinus arrest lasting more than three seconds were detected 52 times per day by 24 hour Holter electrocardiography. Brain MRI disclosed a small hyperintense lesion in the medullary tegmentum on T2-weighted images. She was diagnosed as having a relapse of multiple screlosis and her symptoms were improved by administration of high dose methylprednisolone (1,000 mg per day x 3 days) intravenously. In a patients, a stimulative lesion in the medullary tegmentum was suspected where the reflex centers of hiccups, nausea and blood pressure to exist. We are able to confirm a small hyperintense lesion in such a particular region by brain MRI. In case of syncope accompanied with intractable hiccups and nausea, we should consider a stimulative lesion in the medullary tegmentum. Moreover, sinus arrest other than orthostatic hypotension may be involved in the pathophysiology of syncope in correlation with the medullary tegmentum lesion.

Female↗

PubMed1989

[Digital subtraction angiography in lower extremity phlebography].

DSA was applied to the lower extremity phlebography on 21 cases (36 legs). The patient lay in the supine position and a tourniquet was placed around the ankle. Forty ml of contrast medium, diluted to 25% of the original concentration with normal saline, was injected into the dorsal vein of the foot. The anterior tibial vein, posterior tibial vein, peroneal vein and muscular vein of the calf were identified in 24 (63.2%), 36 (94.7%), 37 (97.4%) and 7 legs (18.4%), respectively. The poor opacification of the anterior tibial vein was attributed partly to the compression effect of the tourniquet. The abnormal findings were deep vein thrombosis (5 legs), reflux from the deep to the superficial vein (14 legs) and irregularity of the venous wall (16 legs). The superficial varicose veins were not demonstrated in DSA phlebography. The examination was comfortable because the patient position was supine and the dilute contrast medium caused no burning sensation. We believe that DSA phlebography is a safe and useful method for diagnosing the deep venous system disorders.

Adult↗

PubMed1987

The predictability of the success of arterial reconstruction by means of transcutaneous oxygen tension measurements.

The cases of 100 patients with severe peripheral vascular disease were reviewed to determine whether the success or feasibility of arterial reconstruction could be correlated with the increase in transcutaneous tissue oxygen tension (tcPO2) that occurs in all persons when assuming an erect posture from the supine position. Resting supine tcPO2 levels of 20 mm Hg or less at the foot were noted in all patients in this study (normal values 60.10 +/- 6.82 mm Hg). Group I patients were defined by an increase of less than 15 mm Hg on standing, whereas group II patients showed an increase of 15 mm Hg or more. Group I patients had a supine tcPO2 value of 4.24 +/- 5.31 mm Hg, with an increase of 3.91 +/- 4.59 mm Hg on standing. The group II subjects also had a low supine tcPO2 level, 5.73 +/- 4.98 mm Hg, but the increase on standing, 36.14 +/- 11.41 mm Hg, was significantly higher (p less than 0.001). When these levels increased by less than 15 mm Hg on standing in group I (31 patients), only 29% of limbs (10 of 34) were saved or had patent grafts at 3 months and 55% of attempted vascular reconstructions (11 of 20) failed. Amputations were performed in 50% of the limbs (17 of 34). This contrasted in group II (69 patients) with a significantly higher limb salvage and graft patency rate (81%, 57 of 70 limbs), success of reconstruction (79%, 37 of 47 procedures), and a significantly lower rate of amputation (11%, 8 of 70 limbs) (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1993

A dynamic pronation orthosis for the C6 tetraplegic arm.

Tetraplegic arms of patients with spinal cord injury at C5 or C6 level are often held in a flexed supinated position. In supination the function of the hand is limited. This report presents a newly developed orthosis giving active pronation of the forearm for a C6 complete tetraplegic. The orthosis consists of a pretightened coiled spring that gives a torque around the longitudinal axis of the forearm. The distal part of the spring is connected to a cuff around the wrist, and the proximal part to two fitting planes on the upper arm. With the orthosis, a 27-year-old patient with a C5-C6 spinal cord injury was able to participate in activities of daily living and to perform table top activities. This new orthosis provides pronation and markedly increases the patient's degree of independence.

Adult↗

PubMed1996

Reproducibility and physiological characteristics of 24-hour ambulatory esophangeal manometry/pH-metry.

OBJECTIVES: To assess the reproducibility and physiological characteristics of ambulatory esophageal manometry/pH-metry. METHODS: Ten healthy volunteers were studied on two separate occasions (2 wk apart) using the Synectics Microdigitrapper System. The pH recording failed in one subject; thus, pH data were analyzed in nine, and motility measurements in all 10 subjects. RESULTS: A high degree of reproducibility was established for the five pH and seven manometry variables assessed. Using the paired t test and Wilcoxon signed rank test to compare the two sets of data, all p values were >0.05. Narrow 95% confidence intervals containing the zero measures were also obtained on the differences of the data from both sessions for all variables. Better correlation coefficients were obtained for the motility parameters than for the pH parameters. As would be expected, reflux occurred more often in the upright than in the supine position. Furthermore, esophageal contractions were of higher amplitude and longer duration in the distal esophagus, and the frequency of propulsive contractions sequences was higher during meals and in the upright position than in the supine position. CONCLUSIONS: This study demonstrates the reproducibility of ambulatory esophageal manometry/pH-metry, suggesting that this technology may be useful in assessing the effect of pharmacological intervention on esophageal motor function.

Adult↗

PubMed1998

[Artifical respiration with patient in prone position].

The use of mechanical ventilation in prone position was proposed 20 years ago. Since then several investigations have been made trying to explain the mechanism whereby oxygenation is improved when the patient with ARDS is turned into the prone position. In supine position the lung perfusion is highest in the dorsal regions in normal healthy persons. However, when patients with ARDS are turned prone, the predominant dorsal perfusion is partly preserved, while at the same time the dorsal atelectases partly resolve, thereby improving the ventilation/perfusion ratio. Sixty-five percent of patients with early ARDS will achieve significant improvement in oxygenation in prone position. It is recommended that patients with early ARDS that remain hypoxic on mechanical ventilation with PEEP and inspiratory oxygen concentration above 60% be turned prone for 3-6 hours. If effective, the treatment can be repeated once or twice daily until regression of hypoxia. The possible effects of the prone position in other types of acute lung failure are so far not known.

Animals↗

PubMed2006

Bowel preparation for CT-colonography: comparison of two different cleansing protocols.

OBJECTIVE: Comparison of cleansing effects and colonic distension observed with two polyethyleneglycol-solution (PEG) containing bowel preparation techniques prior to CT-colonography (CTC). MATERIALS AND METHODS: One hundred and three patients that received CTC in our institution were retrospectively evaluated. Fifty-one patients received preparation 1 (BP1; based on a GoLytely formulation+bisacodyl), 52 preparation 2 (BP2; based on a NuLytely formulation+bisacodyl). On multi-planar-reformatted (MPR) images, fluid residuals and colon distension were assessed in five colonic segments, from the ascending colon to the rectum. RESULTS: On average, significantly (p<0.001) lower fluid residuals were assesses when using BP2 regardless of the patient position. In prone position, a significantly lower fluid level was observed in the sigmoid using bowel preparation 2. The average maximum diameter measured for the whole colon was 5.2+/-0.6 cm in prone position and 4.8+/-0.6 cm in the supine position in BP1 (p<0.01). In BP2 the average maximum diameter measured for the whole colon was 5.3+/-0.6 cm in prone position and 4.7+/-0.5 cm in supine position, respectively (p<0.001). CONCLUSION: Overall, lower fluid residuals were scored using BP2. In both preparation groups we achieved better colonic distension in prone position. We were not able to distend the sigmoid better when insufflating air during patient repositioning.

Bisacodyl↗

PubMed2002

Colour Doppler evaluation of ureteral jets in normal second and third trimester pregnancy: effect of patient position.

The study was designed to investigate the effect of patient position on the detection of ureteral jets in normal pregnancy. The number of jets was recorded for 1 min using colour Doppler ultrasound in 26 healthy asymptomatic gravid women between 16 weeks and 34 weeks gestation. Each patient was examined in the supine position and in both the right and left lateral decubitus positions. Ureteral jets were present on at least one side in 24 patients in the supine position compared with 26 women in the lateral decubitus position. 13 (54%) of the 24 patients in whom jets were seen in the supine position had jets on only one side. A mean of 1.80 jets x min(-1) was detected on the right side and 3.23 jets x min(-1) on the left (p=0.046) in the supine position. In the contralateral decubitus position, jets were detected on the right side in 22 (85%) women and on the left in 25 (96%) women. A mean of 3.07 jets x min(-1) was detected on the right and 4.15 jets x min(-1) on the left. The difference in the frequency of ureteral jets between the supine and lateral decubitus positions was significant (p=0.004 for the right; p=0.011 for the left). However, the difference in the detection rate was significant on only the right side (p=0.016 for the right; p=0.063 for the left). 10 (77%) of 13 patients in whom unilateral absence of ureteral jets was noted had detectable jets in the lateral decubitus position. Our findings demonstrated the utility of the lateral decubitus position in the evaluation of ureters suspicious for obstruction. However, caution is still recommended in diagnosing ureteral obstruction if jets are persistently absent after this manoeuvre.

Adolescent↗

PubMed1997

Effect of body repositioning after venous air embolism. An echocardiographic study.

BACKGROUND: Current therapy for massive venous air embolism (VAE) may include the use of the left lateral recumbent (LLR) position, although its effectiveness has been questioned. This study used transesophageal echocardiography to evaluate the effect of body repositioning on intracardiac air and acute cardiac dimension changes. METHODS: Eighteen anesthetized dogs in the supine position received a venous air injection of 2.5 ml/kg at a rate of 5 ml/ s. After 1 min the dogs were repositioned into either the LLR, LLR 10 degrees head down (LLR-10 degrees), right lateral recumbence, or remained in the supine position. RESULTS: Repositioning after VAE resulted in relocation of intracardiac air to nondependent areas of the right heart. Peak right ventricular (RV) diameter increase and mean arterial pressure decrease were greater in the repositioned animals compared with those in the supine position (P < 0.05). Right ventricular diameter and mean arterial pressure showed an inverse correlation (r = 0.81). Peak left atrial diameter decrease was greater in the LLR and LLR-10 degrees positions compared with the supine position (P < 0.05). Repositioning did not influence peak pulmonary artery pressure increase, and no correlation was found between RV diameter and pulmonary artery pressure. All animals showed electrocardiogram and echocardiographic changes reconcilable with myocardial ischemia. CONCLUSIONS: In dogs, body repositioning after VAE provided no benefit in hemodynamic performance or cardiac dimension changes, although relocation of intracardiac air was demonstrated. Right ventricular air did not appear to result in significant RV outflow obstruction, as pulmonary artery pressure increased uniformly in all groups and was not influenced by the relocation of intracardiac air. The combination of increased RV afterload and arterial hypotension, possibly with subsequent RV ischemia rather than RV outflow obstruction by an airlock appeared to be the primary mechanism for cardiac dysfunction after VAE.

Animals↗

PubMed1997

[Study on measuring blood pressure and heart rate in patients taking antipsychotics].

To decrease the prevalence of orthostatic hypotension in patients taking antipsychotics 62 pchizophrenics' blood pressure and heart rate were measured at different posture. The data showed that the systolic pressure, diastolic pressure and heart rate in supine position were statistically different from those at standing position (P < 0.01). In standing position the heart rate was 41/min higher, the systolic pressure 1.32 kPa lower and the diastolic pressure 1.2 kPa higher than those in supine position. The systolic pressure of 5 cases were normal in supine position and under 12 kPa in standing position. It is concluded that the heart rate and blood pressure should be measured both in standing and supine position in patients taking antipsychotics, so as to prevent the onset of orthostatic hypotension.

Antipsychotic Agents↗

PubMed2000

Biphasic changes in autonomic nervous activity during pregnancy.

To understand the sequential response of the autonomic nervous system to pregnancy, we studied heart rate variability in 23 first trimester, 23 second trimester and 21 third trimester pregnant women. Twenty non-pregnant women were recruited as controls. Time and frequency domain measures of heart rate variability in three recumbent positions were compared. We found that normalized high-frequency power in the supine position increased significantly in the first trimester (42.2 (95% confidence interval (CI) 5.4) nu (normalized unit); P < 0.05) compared with non-pregnant controls (33.0 (6.0) nu), and then decreased progressively in the second (27.3 (6.7) nu) and third (21.8 (6.0) nu; P < 0.05) trimesters. The low-/high-frequency power ratio in the supine position decreased significantly in the first trimester (0.8 (0.3); P < 0.05) compared with that of non-pregnant controls (1.1 (0.3)) and increased progressively in the second (1.5 (0.4)) and third (2.1 (0.8); P < 0.05) trimesters. When the position was changed from the supine to the right lateral decubitus, the percentage change in normalized high-frequency power correlated significantly and negatively with normalized high-frequency power in the supine position in non-pregnant controls (r = -0.56, P = 0.01) and in pregnant women in the first (r = -0.44, P = 0.034), second (r = -0.68, P < 0.001) and third (r = -0.68, P < 0.001) trimesters. These results indicate that autonomic nervous activity shifted towards a lower sympathetic and higher vagal modulation in the first trimester, and changed towards a higher sympathetic and lower vagal modulation in the third trimester as gestational age increased. The balance between the haemodynamic changes of pregnancy and aortocaval compression caused by the enlarging gravid uterus may be responsible for the biphasic changes in autonomic nervous activity during pregnancy.

Adult↗

PubMed2006

Does expiratory flow limitation predict chronic dyspnoea in adults with cystic fibrosis?

Tidal expiratory flow limitation (EFL) may promote dynamic hyperinflation and contribute to chronic dyspnoea. The purpose of this study was to assess the contribution of EFL to chronic dyspnoea in adults with cystic fibrosis (CF). The presence of EFL was determined in 102 adults with stable CF (forced expiratory volume in one second (FEV1) 17.3-91.5% predicted) and 20 age-matched control subjects using the negative expiratory pressure technique. Measurements of inspiratory capacity (IC) and spirometry were performed, and chronic dyspnoea was evaluated using the modified Medical Research Council scale. EFL was present in 34 subjects (33%), with 18 subjects flow limited in the sitting position and 16 subjects flow limited only in the supine position. Flow limitation in the sitting position was associated with older age and lower FEV1 compared with flow-limited supine position and non-flow-limited subjects. A significant reduction in IC accompanied EFL in both the sitting and supine positions. Flow limitation in the sitting position was associated with significantly higher levels of chronic dyspnoea. Ordinal regression analysis indicated that EFL was the best predictor of chronic dyspnoea in a model that included FEV1 % pred. Expiratory flow limitation in cystic fibrosis is associated with reduced forced expiratory volume in one second, older age and dynamic hyperinflation. Expiratory flow limitation significantly contributes to chronic dyspnoea in cystic fibrosis.

Adult↗

PubMed1996

Age-related ocular blood flow changes.

PURPOSE: Pulsatile ocular blood flow (POBF is influenced by well-known parameters, such as intraocular pressure (IOP), heart rate, scleral rigidity, blood pressure, and posture. Age is also likely to influence POBF strongly. The purpose of this study was to evaluate POBF in relation to age in normal subjects. METHODS: Relevant data were collected from a sample of 105 normal subjects, ranging in age from 10 to 80 years. To measure the effect of age on POBF, the subjects were divided into seven groups of 15 subjects each; the age range of each group spanned one decade, beginning with age 10. POBF and pulse amplitude (PA) were measured in sitting and supine positions and after suction cup application. RESULTS: Using linear regression analysis, there was a significant correlation between PA and age in the supine position (P = 0.012) and after suction cup application (P = 0.002); in the sitting position, there was a borderline level of statistical significance (P = 0.053). In the sitting position, POBF was 819 +/- 212 microliters/minute in the second decade and 630 +/- 194 microliters/minute in the eighth decade. In the sitting position and after suction cup application, but not in the supine position, a statistically significant correlation between POBF decrease and age was found with linear regression analysis (P < 0.001 and P = 0.004, respectively). Using multiple regression analysis, POBF values revealed a significant correlation with age (P < 0.001), but not with systolic and diastolic brachial pressure. Considering all the subjects, analysis of variance for repeated measures highlighted a significant decrease of POBF from the sitting to the supine position and associated with an IOP increase (P < 0.001) without significant changes of PA. After suction cup application, there was a significant reduction of both PA and POBF (P < 0.001). CONCLUSIONS: The data revealed that as age increased, PA decreased in all three series of measurements. POBF decreased with age, and in subjects older than 50 years, the decrease was more evident. These findings are especially noticeable after IOP increase with suction cup. It must be considered that the age-related value of POBF is a fundamental parameter to evaluate correctly the hemodynamic aspects of the pathologies affecting the eye.

Adolescent↗

PubMed2001

Effect of lateral versus supine wedged position on development of spinal blockade and hypotension.

Aortocaval compression may not be completely prevented by the supine wedged or tilted positions. It is commonly believed, however, that the unmodified full lateral position after induction of spinal anaesthesia might allow excessive spread of the block. We therefore compared baseline arterial pressures in the supine wedged, sitting, tilted and full lateral positions in 40 women who were about to undergo elective caesarean section. They were then given spinal anaesthesia in the left lateral position and randomised to be turned to the right lateral or the supine wedged position, after which speed of onset and spread of blockade to cold sensation were measured every 2 min for 10 min and mean arterial pressure and ephedrine requirement were recorded every minute for 20 min. Baseline mean arterial pressure was 9 mmHg (95% CI 3 to 14) lower in the left lateral (measured in the upper arm) than in the sitting position; those in the supine wedged and tilted positions were intermediate. Following spinal anaesthesia, hypotension (defined as a reading </=80% of the baseline value in the same position) lasted 2.4 min longer (CI +0.6 to +4.1) in the supine wedged group, but there was no significant difference between the groups in maximum fall or ephedrine requirement. The upper level of block rose more rapidly in the supine wedged than in the lateral group and showed less variability. There is therefore no reason to fear the unmodified lateral group position, which may offer better protection against hypotension.

Clinical Trial↗

PubMed2002

Traumatic subluxation causing variable position of the crystalline lens.

We present a case of traumatic lens subluxation that was evident only when the patient was in the supine position. This case illustrates that a crystalline lens with traumatic zonular rupture can change its position depending on the posture of the patient. If such a lens is suspended by the remaining zonules at the superior quadrant while the patient is erect, phacodonesis may be present while the lens remains in its normal position. However, when the patient is in the supine position, the lens drops back into the vitreous cavity. Examination in erect and supine positions is important in the preoperative assessment of patients with traumatic phacodonesis or iridodonesis.

Aged↗

PubMed1975

Posture and epidural block in pregnant women at term. Effects on arterial blood pressure and limb blood flow.

Upper and lower limb blood flow was measured in 4 fullterm pregnant women in the left lateral and supine positions before and after epidural block. Radial artery mean blood pressure was recorded in 6 full term pregnant women under the same conditions. Before epidural block there was a much greater reduction in lower limb blood flow (39-1%) than in upper limb blood flow (13-5%) when women moved from the lateral to the supine position; this was probably the result of aortic compression. Mean radial artery pressure increased slightly by 4-6% due to maternal overcompensation in the upper part of the body. After epidural block, patients in the lateral position had a mean rise in lower limb blood flow of 25% and a reduction in upper limb blood flow of 37-2%. The mean arterial pressure remained unchanged. In the supine position there was no further reduction of upper limb blood flow; this was accompanied on average by a 9% fall in mean radial arterial pressure indicating decompensation in the mother. The leg blood flow fell less, 26-9% than before epidural block. In the supine position, a greater flow to the legs, associated with a decreased mean arterial pressure, would be expected to lead to a diminution in placental perfusion, which is the probable mechanism for foetal decompensation. Therefore the supine position should be avoided with an epidural block. In other patients it would be wise not to rely upon maternal compensatory mechanisms.

Anesthesia, Epidural↗

PubMed1988

[Influence of posture on exercise-induced electrocardiographic and hemodynamic changes in patients with stable effort angina pectoris].

The present work was performed in order to assess the differences in electrocardiographic and hemodynamic responses to supine and upright dynamic exercise of patients with coronary artery disease. Changes in heart rate (HR), systolic (SBP) and diastolic (DBP) blood pressure, rate-pressure product (RPP) and ST segment depression during supine and upright bicycle stress test were compared in twenty patients suffering from stable effort angina and without previous myocardial infarction. In the supine posture lower values of HR were observed at rest, during stress test and during three minutes of the recovery period. Conversely, in all patients both SBP and DBP were higher during the stress test in the supine position decubitus. No significant changes in RPP was observed between the two different postures. Finally, ST segment didn't show differences at rest between the upright and supine position. All the patients had a lower ischemic threshold during exercise in the supine position than in the upright one. In fact an ST segment depression greater than 1 mm was observed during stress test in the supine position at lower work-load levels and at lesser HR values. Consequently for given HR, SBP and DBP ST segment, depression was greater in the supine rather than in the upright position.

Adult↗