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Results for “Supine Position”

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PubMed2004

Inclusion of epinephrine to hyperbaric tetracaine and the supine position enhance the cephalad spread of spinal anaesthesia compared with hyperbaric teracaine alone in the lithotomy position.

BACKGROUND: Intrathecal epinephrine can produce prolongation of duration of spinal anaesthesia by reducing vascular absorption of the local anaesthetics. The patient's positioning can change the cephalad spread of hyperbaric local anaesthetics by affecting the lordosis of the vertebral canal. These factors combined are expected to affect the cephalad spread of sensory block levels. The purpose of this study was to investigate whether combined use of epinephrine with hyperbaric tetracaine in the supine position can enhance the cephalad spread of sensory block levels compared with hyperbaric tetracaine alone in the lithotomy position. METHODS: ASA physical status I or II 48 urological (lithotomy group) and 48 orthopaedic patients (supine group) scheduled to undergo elective surgical procedures in the lithotomy or supine position under spinal anaesthesia were enrolled. Patients in each group were randomly divided into two subgroups to receive intrathecal 10 mg of hyperbaric tetracaine with or without 0.2 mg of epinephrine (Groups L, LE, S, and SE). The extent of sensory blockade was assessed by loss of cold sensation. After achievement of sensory blockade up to T10, the patients in Groups L and LE were immediately placed in the lithotomy position. Patients in Groups S and SE were maintained in the supine position. RESULTS: The highest sensory blockade in the SE Group was on average statistically significantly higher than in the L Group. The mean time taken to the highest sensory blockade in the SE Group was statistically significantly longer than in Groups L and S. Atropine for bradycardia was used more frequently in the SE Group than in the other groups. CONCLUSIONS: Combined use of epinephrine with hyperbaric tetracaine in the supine position can enhance the cephalad spread of sensory block levels compared with hyperbaric tetracaine alone in the lithotomy position.

Aged↗

PubMedDate not supplied

Does supine positioning increase apnea, bradycardia, and desaturation in preterm infants?

OBJECTIVE: The purpose of this study was to determine the effects of prone and supine positioning on the cardiorespiratory stability of preterm infants with apnea and bradycardia. METHODS: A total of 22 preterm infants with symptomatic apnea and bradycardia (gestational age of 26.9 +/- 1.8 weeks and birth weight of 865 +/- 235 gm) were monitored for 24 hours (in four sequential 6-hour blocks) for apnea, bradycardia, and oxygen desaturation in alternating positions (prone or supine) following randomization. Postconceptional age at the time of study was 31.9 +/- 3.0 weeks. Respiratory rate, heart rate, and transcutaneous oxygen saturation were continuously monitored. All episodes of apnea (> or = 10 seconds), bradycardia (< 100 beats per minute), and oxygen desaturation (< 90%) were recorded on an event monitor. Episodes of apnea, bradycardia, and oxygen desaturation were defined as clinically significant if the following criteria were met: apnea, > or = 15 seconds; bradycardia, < 90 beats per minute; and oxygen desaturation, < 80%. All other recorded episodes were considered mild. The episodes were analyzed for statistical significance using the paired t-test. RESULTS: No significant differences (p > 0.05) in the incidence of clinically significant apnea, bradycardia, or desaturation between supine and prone positions were seen in these preterm infants. CONCLUSION: Our results suggest that the cardiorespiratory stability of preterm infants is not significantly compromised by supine positioning.

Apnea↗

PubMed1978

Inclined or conventional supine position in ultrasonic examinations in late pregnancy.

Ultrasonic examinations were made on 22 patients in late pregnancy both in the conventional supine position and in an inclined position. The findings give rise to the following conclusions: 1) The inclined position prevents the development of the vena cava inferior syndrome. 2) The examinations can be made as easily and accurately in the inclined as in the conventional supine position. 3) In cases where the head is in the occipito-posterior position the inclined position may increase the reliability of the measurement of the biparietal diamter. The authors consider it recommendable to use the inclined position instead of the conventional supine position in ultrasonic examinations to maintain both maternal and fetal well-being during the procedure.

Female↗

PubMed1977

Cervical traction. A comparison of sitting and supine positions.

Eight students were studied todetermine the position which provided the greatest amount of posterior intervertebral separation during a cervical traction treatment. A standard angle of 45 degrees with traction apparatus set at zero, 14 Kg (30 pounds), and 18 Kg (40 pounds) were used in both sitting and supine positions. Measurements of posterior intervertebral separation taken from lateral roentgenograms of the C4-C7 vertebrae revealed greater separation in the supine positions. The results suggested that the supine position was more beneficial in treatment of the cervical spine with traction. The investigators concluded that the increased separation in the supine position was related to the patient's increased comfort and relaxation.

Adult↗

PubMed1984

Pleural effusion. Use of the semi-supine position for radiographic detection.

Chest radiographs of 100 routinely examined patients were evaluated to study the effectiveness of the oblique semi-supine position when attempting to identify pleural effusion. Comparisons were made to images obtained with the patient in the lateral decubitus position. Radiography was performed without noticeable discomfort for 62 patients in the lateral decubitus position and for 97 patients in the oblique semi-supine position. The visualization of free pleural fluid was not affected by the different body positions, but demonstration of encapsulated fluid was superior in views obtained with the patient in the oblique semi-supine posture. For most individuals with suspected pleural effusion, the oblique semi-supine position is preferable to the lateral decubitus position.

Adolescent↗

PubMed2000

[Evaluation of varicocele by ultrasonography through a water bag in the supine position].

Recently, ultrasonography has been widely used to evaluate varicocele. However, it is difficult to obtain reproducible scrotal images with a hand probe in the standing position. We, therefore, applied the water bag technique during ultrasonographic examination of the scrotal contents in the supine position. The ultrasonographic images thus obtained were compared with physical findings and scrotal scintigraphic findings. Forty-five varicocele patients diagnosed by palpation and ultrasonography were enrolled in this study. An ultrasonographic examination through a water bag in the supine position has the following advantages 1) it is easy to perform and stable images are obtained, 2) varicoceles that are not palpable can be detected and 3) examinations can be repeated both pre- and postoperatively. Of the 45 patients, 39 and 41 had positive findings on the ultrasonographic images and physical examinations, respectively. Four patients had negative findings on physical examination but positive findings on the ultrasonographic images. Thus, ultrasonographic images through a water bag in the supine position proved to be a useful method of confirming the hemodynamics in varicoceles.

Adolescent↗

PubMed1998

Distribution of scattered radiation during intraoral radiography with the patient in supine position.

OBJECTIVE: The purpose of this study was to investigate the spatial distribution of scattered radiation during intraoral radiography with the patient in a supine position to determine the exposure to an operator without a suitable barrier. STUDY DESIGN: A phantom was placed in the supine position on a dental chair with the occlusal plane perpendicular to the floor, and four intraoral periapical radiographic examinations in the anterior and posterior regions of the maxilla and mandible were performed. The scattered radiation was measured with an ionization chamber at distances ranging from 25 to 200 cm at 25 cm increments and at intervals of 45 degrees. Measurements were made at two different heights: level with the occlusal plane and 30 cm below it. The exposure was converted to an air-kerma/absorbed dose in air. RESULTS: The distribution of scattered radiation was symmetric during examinations of the anterior region. Circular iso-exposure curves of up to 0.5 microGy were observed at the level of the occlusal plane, and curves of up to 0.1 microGy were observed 30 cm below the plane. The lowest exposures were measured 30 cm below the occlusal plane and behind the chair. The distribution of scattered radiation was not symmetric during examinations of the posterior region. Iso-exposure curves of up to 0.25 microGy were observed at the level of the occlusal plane during exposure of the maxilla, and curves of up to 0.5 microGy were observed during exposure of the mandible. Circular iso-exposure curves of up to 0.1 microGy were observed 30 cm below the occlusal plane. Lower values for scattered radiation were observed 30 cm below the occlusal plane between 135 and 180 degrees behind the phantom. CONCLUSION: The spatial distribution of scattered radiation with the patient in a supine position was not the same in eight directions around the chair. Although the preferred position for the operator is behind a suitable barrier, the preferred position in the absence of a barrier is 200 cm behind the patient.

Dental Auxiliaries↗

PubMed1996

Anatomical configuration of the spinal column in the supine position. III. Comparison of adolescent and adult volunteers.

To clarify the anatomical configuration of the spinal column in the adolescent in the supine position, we have studied 10 adolescent (13-17 yr) and 10 adult (26-38 yr) volunteers using magnetic resonance imaging. T1-weighted sagittal midline magnetic resonance images of the spinal column were obtained with subjects in the supine position. The maximum angles of decline of the lumbar spinal canal did not differ between the adolescent (mean 13.6 (SD 3.3) degrees) and adult (12.4 (3.8) degrees) groups. The maximum angles of incline of the upper thoracic spinal canal were smaller in the adolescent group (15.9 (4.7) degrees) than in the adult group (26.4 (5.8) degrees). The median highest point of the lumbar spinal canal was located at L4 (range L3-4 to L4-5) in both groups. The lowest points of the thoracic spinal canal in the adolescent and adult groups were located at T8-9 (T7 to T9) and T8 (T6-7 to T9), respectively. This study showed that thoracic kyphotic curvature in adolescents was reduced significantly in the supine position compared with that in adults. This minimized thoracic kyphosis may explain, in part, the enhanced cephalad spread of subarachnoid hyperbaric anaesthetic solutions in adolescents.

Adolescent↗

PubMed1991

Effect of left-lateral position on maternal hemodynamics during ritodrine treatment in comparison with supine position.

Pregnant women are generally recommended to rest in the left-lateral position (l-lat.) to avoid caval compression. We studied the influence of postural change from the supine position (sup.) to the l-lat. on maternal hemodynamics and tocolysis. The cardiac output (CO) was measured by impedance cardiography, while the pulsatility index of the uterine artery (PIUtA) was determined by the pulsed Doppler method. When the maternal posture was changed from sup. to l-lat, the following results were obtained. (1) The frequency of uterine contractions (UC) (preterm labor = 92) was significantly reduced (p less than 0.01). (2) The resting uterine tonus (n = 5) was also significantly decreased (p less than 0.05). (3) In the cases showing a decrease in the frequency of UC, the CO value was significantly increased (p less than 0.01), whereas PIUtA was significantly decreased (p less than 0.01). It is concluded that the postural change from sup. to l-lat. resulted in a decrease in the frequency of UC and the resting uterine tonus and at the same time an increase in the CO and decrease in the vascular resistance of the uterine artery.

Cardiac Output↗

PubMed1992

Why deliver in the supine position?

This study was conducted at the Lokmanya Tilak Municipal General Hospital, Bombay, India during the year 1990. The aim was to compare the routinely used supine position versus ambulation in the first stage and squatting position during the second stage of labour. Our study was comprised of 200 patients both primigravidas and multigravidas; 100 were kept in the supine position throughout labour and 100 were kept ambulatory in the first stage and adopted the squatting position during the second stage. The study showed a shortening of both stages of labour in the squatting group but the incidence of complications was less in the control group. It was concluded that without proper birthing chairs which can give excellent perineal support, the usual supine position is preferable in our setup.

Adult↗

PubMed1995

Anatomical configuration of the spinal column in the supine position. II. Comparison of pregnant and non-pregnant women.

To assess the changes in the curvature of the spinal column in the supine position during pregnancy, we studied seven pregnant (32-37 weeks of pregnancy) and seven non-pregnant women using magnetic resonance imaging. T1-weighted sagittal midline magnetic resonance images of the spinal column were obtained with subjects in the supine position with left tilt. There was no significant difference in the maximum angle of decline of the lumbar spinal canal between the pregnant (mean 12.4 (SD 3.3) degrees) and non-pregnant (13.4 (3.9) degrees) groups. The maximum angle of incline of the upper thoracic spinal canal was smaller in the pregnant (15.8 (2.9) degrees) than in the non-pregnant (22.7 (6.0) degrees) group. The highest point of the lumbar spinal canal was located at a lower lumbar region in the pregnant (median L4-5 (range L4 to L4-5)) than in the non-pregnant (L4 (L3-4 to L4)) group. The lowest point of the thoracic spinal canal was located at a higher thoracic region in the pregnant (T6-7 (T6 to T7-8)) than in the non-pregnant (T8 (T6-7 to T9)) group. This study revealed that the apex of lumbar lordosis was caudad and thoracic kyphosis was reduced in the supine position in the later stages of pregnancy. These changes in the curvature of the spinal column may explain, in part, the enhanced cephalad spread of subarachnoid hyperbaric anaesthetic solutions in the later stages of pregnancy.

Adult↗

PubMed1996

Does the supine position worsen respiratory function in elderly subjects?

The aim of our study was to test whether the supine position or the sitting position worsens static, forced expiratory flows and measurements of lung mechanics in a group of aged subjects living in a nursing home who were clinically stable and without clinical evidence of cardiorespiratory diseases. Seventeen subjects (mean age 80 +/- 7 years; 16 f) were studied under baseline conditions. Spirometric, breathing pattern and mechanics data by means of an esophageal balloon were measured in sitting and supine positions. Analysis of sitting results showed aged subjects to have a slight flow limitation in peripheral airways, an increase in expiratory airways resistance and mild hyperinflation index (PEEPi = 2.2 +/- 1.9 cm H2O). Pressure time index did not reach the fatigue level in hardly any patient. Maximal inspiratory pressure values (42 +/- 15 cm H2O) were reduced by about 50% in comparison with our normal laboratory standards. Arterial blood gas analysis revealed no pathological data in any subject. When supine, subjects revealed a significant decrease in forced expiratory volume at the first second (p < 0.005), in forced vital capacity (p < 0.01) and in peak expiratory flow (p < 0.05). Moreover, mechanics and breathing pattern data showed a significant decrease in tidal volume (Vt) and dynamic lung compliance (Cld) (p < 0.05) and an increase in respiratory rate/Vt ratio (p < 0.05). Our data confirm the results of previous reports about Cld decrease in supine posture in young normal people. Although our aged subjects showed a significant decrease in forced expiratory volumes and Vt when the supine position was adopted, static mechanics data did not appear modified by the gravitational effect of this posture.

Aged↗

PubMedDate not supplied

Hepatodiaphragmatic interposition of the colon in the upright and supine position.

OBJECTIVE: Hepatodiaphragmatic interposition of the colon (HDIC) has been previously evaluated with chest radiography (CR) of patients examined in an erect position. In this work the presence of HDIC was assessed in patients who underwent CT in the supine position. MATERIALS AND METHODS: In 1,440 patients, 806 men and 634 women, 19-83 years old subjected to CR and abdominal CT for various indications, HDIC was retrospectively evaluated. RESULTS: In 2.4% of the patients HDIC was found using CT in the supine position but in only 0.3% on CR. The variation appeared more frequently in men than in women and in older adults and individuals with an increased amount of intraabdominal fat. This latter finding may represent an additional factor favoring malposition of the colon. CONCLUSION: The results of this study indicate that HDIC has a significantly greater incidence in the supine position of patients, and it can not be excluded on the basis of negative CR.

Adipose Tissue↗

PubMed2004

Extraperitoneal laparoscopic retroperitoneal lymph node dissection in supine position after chemotherapy for advanced testicular carcinoma.

AIM: To evaluate the feasibility and usefulness of extraperitoneal laparoscopic retroperitoneal lymph node dissection (RPLND) in the supine position after chemotherapy for advanced testicular carcinoma. METHODS: Three patients with advanced testicular cancer underwent chemotherapy. Although serum markers were decreased compared with the normal range, residual masses requiring surgical resection were recognized by computed tomography scanning. We applied extraperitoneal laparoscopic RPLND. The patients were placed in the supine position and the first trocar was inserted two finger widths medial to the anterior iliac spine. The retroperitoneal space was dilated using a preperitoneal distention balloon. Two more ports were inserted into the retroperitoneal space and surgery proceeded thereafter. RESULTS: The residual tumors were completely resected by laparoscopy. The procedure required 250-310 min and the bleeding volume was below 50 mL. Although the histopathological findings consisted only of necrosis in all of the patients, one patient recurred at the same place. CONCLUSIONS: Extraperitoneal laparoscopic RPLND in the supine position for residual tumors after chemotherapy is technically feasible and useful in terms of postoperative recovery. With regard to cancer control, further evaluation should be necessary.

Adult↗

PubMedDate not supplied

Measurement of vertebral rotation in standing versus supine position in adolescent idiopathic scoliosis.

Thirty-three structural curves of 25 patients with adolescent idiopathic scoliosis were evaluated using computed tomography (CT) scans and plain radiography. The average Cobb angle on standing radiographs was 55.72 degrees and was observed to be corrected spontaneously to 39.42 degrees while the patients were in supine position (29.78% correction). Average apical rotation according to Perdriolle was 22.75 degrees on standing radiographs and 16.78 degrees on supine scanograms. The average rotation according to Aaro and Dahlborn on CT scans was 16.48 degrees. Radiographic measurements were significantly different from axial CT slice or scanogram measurements (p = 0.000), but the two latter measurements, both obtained in the supine position, did not appear to be different (p = 0.495). Deformities on the transverse plane as well as on the coronal plane are influenced by patient positioning. If the patient lies supine, the scoliosis curve corrects spontaneously to some degree on both planes. Measurements obtained from the scanograms by the Perdriolle method in the supine position are very similar to those obtained by CT. Perdriolle's is a simple, convenient, and reliable method to measure rotation on standing radiograms.

Adolescent↗

PubMed2006

Increased incidence of apparently life-threatening events due to supine position.

Gastro-oesophageal reflux (GOR) has a high prevalence in infancy. The supine position is among numerous aggravating factors. The exact relationship between GOR and apparently life-threatening events (ALTE) is not clear, although it has been repeatedly investigated. In 1992 the worldwide Back to Sleep campaign was implemented, which had a dramatic effect on the incidence of sudden infant death syndrome (SIDS) with a drop of 50%. Although the vast majority of children now sleep on their back, the effect of this position on ALTE has not been studied. In this retrospective study, we aim to define the potential association between GOR and ALTE. We hypothesise that the incidence of ALTE has increased since the 1992 recommendation. No bias in the population's selection was introduced, as our centre is the only one for paediatric emergencies in the county. A total of 107 children presenting with ALTE were identified during the study period (1987-99). A pH study was performed in the 75 patients presenting with ALTE in the last 6 years of the study (1994-99). Neither morbidity nor mortality was noted in a long-term 4-year follow-up. Our present results show that the frequency of ALTE increased sevenfold (P < 0.005) between 1992 and 1999. The ALTE episodes took place significantly more often in the post-prandial period. The prevalence of GOR was much higher in patients presenting with ALTE (nearly 75%) when compared with the general population. Furthermore, on medical treatment for GOR, very few patients presented with a second episode of ALTE. Consequently it is thought that GOR and ALTE are linked and that ALTE patients would benefit from GOR treatment. The worldwide marked decrease in SIDS since the implementation of the supine position possibly masks the negative effect of an increase in ALTE.

Female↗

PubMed1977

Argon laser treatment in supine position.

When using an argon laser photocoagulator it is often advantageous and sometimes indispensable to treat the patient in a supine position. Stabilization of the laser beam requires the use of a microscope equipped with a beam manipulator (joystick) that maintains the orientation of the laser beam wherever it is placed, without the operator having to hold the joystick. A low-vacuum contact lens or a three-mirror lens, and a microscope suspended from a floor stand are used. The patient is placed in the supine position on a stretcher of adjustable height with his head in a foam rubber conformer. Local anesthesia may not be necessary, but if indicated, the patient should not be treated in an upright position. A lid block is rarely required. General anesthesia is used with patients who cannot cooperate. There are 4 main indications for treatment in the supine position: (1) cases in which great accuracy is needed, such as treatment near the macula; (2) all cases in which retrobulbar anesthesia is necessary, with or without a lid block; (3) cases in which the patient is unable to cooperate; and (4) cases that require prolonged photocoagulation.

Adult↗

PubMed1995

Laparoscopic sterilization in the supine position using the Ramathibodi uterine manipulator.

OBJECTIVES: To investigate the usefulness of the Ramathibodi uterine manipulator (AMZURA Enterprises, Freeport, NY) in performing laparoscopic sterilization procedures in the supine position under local anesthesia. DESIGN: Descriptive prospective study. SETTING: Ambulatory surgical unit of university-affiliated hospital. PATIENTS: Women presenting for elective sterilization and weighing < 110 kg. INTERVENTION: The Ramathibodi uterine manipulator was used to provide uterine manipulation in 85 cases of laparoscopic sterilization, all performed in the supine position as local anesthesia-sedation sterilization operations. Because such procedures are becoming more common worldwide, we propose the acronym "LASSO" (Local Anesthesia-Sedation Sterilization Operation) for this class of operations. Although commonly used in minilaparotomy procedures, use of this uterine manipulation device in laparoscopic procedures has not been published previously. MAIN OUTCOME MEASURE: Successful tubal occlusion. RESULTS: Among the 85 cases reported here there were no failures to manipulate the uterus successfully, to identify the tubes, and to occlude them. CONCLUSIONS: The simplicity of the Ramathibodi uterine manipulator provided several advantages over other means of uterine manipulation, notably [1] constant easy-to-learn maneuvers, [2] no tenaculum or balloon requirement, [3] the procedure could be performed in the supine position, and [4] there are no working parts, screws, or springs that could be lost or broken by operating room staff. Our experience with this device leads us to recommend it to colleagues as an inexpensive, safe, and effective alternative to currently available instruments for providing uterine elevation during laparoscopic sterilization procedures.

Anesthesia, Local↗