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Results for “Prone Position”

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At least 865 records · Page 48Linked to original sources

PubMed2006

Arterial blood flow and autonomic function in full-term infants.

OBJECTIVES: To investigate variations in the autonomic functions and blood-flow velocity of the arteries supplying to the brainstem in supine and prone positions. METHODS: Forty-one full-term infants were studied at the age of 24-72 h. Each infant underwent respiratory, cardiac and eye movement analyses in supine and prone positions. In addition, blood-flow velocity of the basilar and vertebral arteries was measured with a 2 MHz probe for 5 min in each position. Two time domain measures of heart rate variability (HRV) (Standard deviation of normal R-R intervals for long-term and pNN50 for short-term variability) were employed. RESULTS: Significantly decreased short- (P<0.001) and long (P = 0.003)-term variabilities were observed in prone when compared with supine position. Increased short-term variability in active sleep with no interaction with position was observed (P = 0.005). A significant decreased mean (P = 0.001) and peak (P = 0.001-0.003) blood-flow velocity in prone when compared with supine position were measured in all three arteries supplying to the brainstem. No significant correlation between HRV and arterial blood-flow velocity (ABFV) was observed in either position. COMMENT: The results of the present study in agreement with previous studies reflect the vulnerability of infants in prone position as related to brainstem function. However, it appears that ABFV and autonomic functions as reflected by HRV are independent physiological measures, possibly indicating regulation autonomy of the central nervous system.

Autonomic Nervous System↗

PubMed1992

Spatial orientation of the vestibular system.

1. A simplified three-dimensional state space model of visual vestibular interaction was formulated. Matrix and dynamical system operators representing coupling from the semicircular canals and the visual system to the velocity storage integrator were incorporated into the model. 2. It was postulated that the system matrix for a tilted position was a composition of two linear transformations of the system matrix for the upright position. One transformation modifies the eigenvalues of the system matrix while another rotates the pitch and roll eigenvectors with the head, while maintaining the yaw axis eigenvector approximately spatially invariant. Using this representation, the response characteristics of the pitch, roll, and yaw eye velocity were obtained in terms of the eigenvalues and associated eigenvectors. 3. Using OKAN data obtained from monkeys and comparing to the model predictions, the eigenvalues and eigenvectors of the system matrix were identified as a function of tilt to the side or of tilt to the prone positions, using a modification of the Marquardt algorithm. The yaw eigenvector for right-side-down tilt and for downward pitch cross-coupling was approximately 30 degrees from the spatial vertical. For the prone position, the eigenvector was computed to be approximately 20 degrees relative to the spatial vertical. For both side-down and prone positions, oblique OKN induced along eigenvector directions generated OKAN which decayed to zero along a straight line with approximately a single time constant. This was verified by a spectral analysis of the residual sequence about the straight line fit to the decaying data. The residual sequence was associated with a narrow autocorrelation function and a wide power spectrum. 4. Parameters found using the Marquardt algorithm were incorporated into the model. Diagonal matrices in a head coordinate frame were introduced to represent the direct pathway and the coupling of the visual system to the integrator. Model simulations predicted the behavior of yaw and pitch OKN and OKAN when the animal was upright, as well as the cross-coupling in the tilted position. The trajectories in velocity space were also accurately simulated. 5. There were similarities between the monkey eigenvectors and human perception of the spatial vertical. For side-down tilts and downward eye velocity cross-coupling, there was only an Aubert (A) effect. For upward eye velocity cross-coupling there were both Müller (E) and Aubert (A) effects. The mean of the eigenvectors for upward and downward eye velocities overlay human 1 x g perceptual data.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗

PubMed2000

Prevention of positional brachial plexopathy during surgical correction of scoliosis.

Continuous intraoperative monitoring of spinal cord function using somatosensory evoked potentials (SSEP) has gained nearly universal acceptance as a reliable and sensitive method for detecting and possibly preventing neurologic injury during surgical correction of spinal deformities. In several reports, spinal cord injury was identified successfully based on changes in SSEP response characteristics, specifically amplitude and latency. Less well documented and used, however, is monitoring of peripheral nerve function with SSEPs to identify and prevent the neurologic sequelae of prolonged prone positioning on a spinal frame. The authors describe a patient who underwent surgical removal of spinal instrumentation but was not monitored. A brachial plexopathy developed in this patient from pressure on the axilla exerted by a Relton-Hall positioning frame during spinal surgery. In addition, data are presented from 15 of 500 consecutive pediatric patients who underwent surgical correction of scoliosis between 1993 and 1997 with whom intermittent monitoring of ulnar nerve SSEPs was used successfully to identify impending brachial plexopathy, a complication of prone positioning. A statistically significant reduction in ulnar nerve SSEP amplitude was observed in 18 limbs of the 500 patients (3.6%) reviewed. Repositioning the arm(s) or shoulders resulted in nearly immediate improvement of SSEP amplitude, and all awoke without signs of brachial plexopathy. This complication can be avoided by monitoring SSEPs to ulnar nerve stimulation for patients placed in the prone position during spinal surgery.

Adult↗

PubMed1995

Measurement of irradiated small bowel volume in pelvic irradiation and the effect of a bellyboard.

From June 1992 to January 1993, 51 consecutive patients with pelvic cancers treated with radiotherapy alone, or surgery plus post-operative radiotherapy, were included in a study of the effectiveness of a false table-top (bellyboard) in displacing small bowel loops out of anteriorposterior (AP) and posterioranterior (PA) opposing pelvic fields. The small bowel was opacified with barium. The volume of small bowel within the radiotherapy fields in the prone position with a bellyboard was reduced by 134-300 ml (29%-61%) when compared with that in supine position, and by 136-216 ml (28%-50%) when compared with that in prone position without a bellyboard, depending on the type of previous surgical procedures. The differences were highly statistically significant and likely to be clinically significant. The bellyboard we used is simple, economical, convenient and well tolerated. Its use is recommended, especially when AP and PA pelvic fields are used.

Adult↗

PubMedDate not supplied

Neuromotor development and the physiologic effects of positioning in very low birth weight infants.

OBJECTIVE: To provide a comprehensive literature review of neuromotor development and related physiologic effects of positioning in very low birth weight infants. DATA SOURCES: MEDLINE, CINHAL, Health Star, Current Contents, and the Australian Medical Index (1966-2000) databases were searched. Unpublished studies (e.g., dissertations, conference proceedings) and all relevant references listed in articles also were examined. STUDY SELECTION: One hundred and eighty theoretical writings, research studies, and clinical papers related to neuromotor development, the physiologic effects of positioning, and interventions to minimize or prevent short- and long-term effects of positioning in very low birth weight infants were reviewed. DATA EXTRACTION: Studies were assessed for scientific rigor, evidence of theoretical foundation, and clinical relevance. Comparisons were made across data sources to determine the most reliable, valid, and consistent findings. DATA SYNTHESIS: Three compelling results emerged: (a) The development of posture and mobility in newborn infants requires an optimal balance between active and passive muscle tone, (b) the prone position is physiologically more beneficial for the preterm infant than supine and lateral positions, and (c) the prone position can lead to short- and long-term postural and associated developmental problems. CONCLUSION: Use of empirically tested postural interventions appropriate for an infant's gestational age, health status, and overall organizational capacity is recommended.

Child Development↗

PubMed2005

[Effects of lung protective ventilation in prone or supine position on inhibiting adrenomedullin release in acute respiratory distress syndrome caused by pulmonary and extra-pulmonary insults in dog].

OBJECTIVE: To investigate the changes in adrenomedullin release in bronchial alveolar lavage fluid (BALF) from different lung areas in acute respiratory distress syndrome (ARDS) of produced dogs, by pulmonary and extra-pulmonary causes, with low tidal volume and positive end expiratory pressure (PEEP) treatment under supine and prone position. METHODS: Twenty-four male mongrel dogs were randomly divided into ARDSp (ARDS caused by pulmonary causes) supine group, ARDSp prone group, ARDSexp (ARDS caused by extra-pulmonary causes) supine group, and ARDSexp prone group. A detergent to cause lung injury in ARDSp dogs, and intravenous oleic acid was given in ARDSexp dogs. The results of adrenomedullin in different areas of dog's lung (upper lobe, middle lobe, and lower lobe) and arterial blood gas under lung protective ventilation treatment were measured. RESULTS: After lung injury, the arterial oxygenation index was lowered, and the levels of adrenomedullin in the upper lobe and middle lobe of ARDSp dogs were higher than that of ARDSexp dogs. After receiving low tidal volume and PEEP ventilation, the conditions of all the dogs were gradually getting ameliorated, and prone position ventilation gave better effects on lung injury dogs by inhibiting adrenomedullin release. CONCLUSION: There are statistical differences in adrenomedullin release in different lung areas between ARDSp dogs and ARDSexp dogs, and in both ARDSexp dogs and ARDSp dogs low tidal volume and PEEP treatment under prone position ventilation give better results compared to supine position.

Adrenomedullin↗

PubMed2002

A systematic review of nonpharmacological and nonsurgical therapies for gastroesophageal reflux in infants.

BACKGROUND: Nonpharmacological and nonsurgical measures are often recommended for gastroesophageal reflux disease (GERD) in infants, despite ambiguous supporting evidence. OBJECTIVE: To conduct a systematic review of rigorously evaluated nonpharmacological and nonsurgical therapies for GERD in infants. DESIGN/METHODS: We searched online bibliographic databases, including MEDLINE, EMBASE, the Cochrane Collaboration and Clinical Trials Database, and alternative medicine databases for the terms gastroesophageal reflux and infants. We selected randomized controlled trials of nonpharmacological and nonsurgical GERD therapies in otherwise healthy infants. Data were extracted from the selected articles regarding reflux, emetic episodes and intraesophageal pH. RESULTS: We identified 43 relevant studies, of which 10 met the selection criteria. These studies examined positioning, pacifier use, and feeding changes. Positioning at a 60 degree elevation in an infant seat was found to increase reflux compared with the prone position. No significant difference was shown between the flat and head-elevated prone positions. The impact of pacifier use on reflux frequency was equivocal and dependent on infant position. The protein content of formula was not found to affect reflux. Although no study demonstrated a significant reflux-reducing benefit of thickened infant foods compared with placebo, 1 study detected a significant benefit of formula thickened with carob bean gum compared with rice flour (pH<4 for 5% vs 8% of time). Another study showed that if supplementing with dextrose 5% water or dextrose 10% water, the lower-osmolality fluid was associated with less reflux. CONCLUSIONS: Many conservative measures commonly used to treat GERD in infants have no proven efficacy. Although thickened formulas do not appear to reduce measurable reflux, they may reduce vomiting. Further studies with clinical outcomes are needed to answer questions about efficacy definitively.

Gastroesophageal Reflux↗

PubMed2004

Endoscopic medial parascapular approach to the thoracic spine.

BACKGROUND: The traditional endoscopic-assisted approaches to the thoracic spine between the 4th and 8th thoracic vertebrae, whether in lateral or prone positions, are done ventrolateral to the scapula. Accordingly, the distance between the working portal and the spinal target is relatively long, and this increases the difficulty of the endoscopic surgery. Exposure of the spinal target necessitates excessive retraction and/or deflation of the corresponding lung. Both maneuvers are undesirable, particularly in old people with chronic obstructive lung disease. METHODS: This paper describes an endoscopic-assisted medial parascapular approach in the prone position that offers the surgeon a relatively short access to the upper-mid-thoracic spine. Fifteen patients (10 men and five women), mean age 68 years, with anterior lesions located between the 4th and 8th thoracic vertebrae, constituted this prospective study. The type of the anterior endoscopic procedure varied according to the surgical indication and was as follows; biopsy from a paravertebral swelling in two patients, debridement and fusion in four patients with spondylodiscitis, corpectomy and replacement with telescope cage (X-Tenz) in five patients with spinal tumors, corpectomy and replacement with X-Tenz in two patients with vertebral osteonecrosis, and intersomatic fusion in two patients with fractures. Posterior transpedicular fixation was done in 13 patients in the same sitting. RESULTS: Conversion to open thoracotomy was not needed. There were no instances of spinal wound infections, neurological deficits, dural tears or vascular injuries. Subcutaneous emphysema developed in one patient and resolved spontaneously. The mean blood loss was 1006.7 ml. Neither pseudarthrosis nor metal failure was encountered. The segmental kyphotic angle decreased from 13.6 degrees at the preoperative period to 9.6 degrees at the immediate postoperative period and reached 11.7 degrees at the end of the follow-up. CONCLUSIONS: The endoscopic medial parascapular approach, done in the prone position, provides the shortest access to anterior spinal lesions between the 4th and 8th thoracic vertebrae. This approach is associated with minimal manipulation and retraction of the lung so that a double-lumen tube is not needed.

Aged↗

PubMed2003

[Prevention of sudden infant death in Germany].

In Germany there are several committed which however haven't got together yet in order to set up a systematic health education campaign. So far the knowledge of other professional fields like that of graphic designers, specialists of communication and public health scientists hasn't been sufficiently used to familiarize nearly all pregnant women, parents, grandparents and babysitters with those known medical subject matters. Hopefully paediatricians, gynaecologists, children's nurses, midwives, breast-feeding consultants, paediatric preventive assistants, consultants for pregnant women who smoke and mothers in general will soon start to get going an effective lasting and possibly nationwide preventive campaign which will be supported by the competent social ministries and financing authorities, self-help groups, graphic designers, specialists for communication and public health scientists. The aim should be to reduce the amount of sudden infant death cases to or even below the level of The Netherlands (minimum figure in 2002: 0.11 SID cases per 1.000 live births). Already in 1972-15 years before the beginning of the Dutch preventive campaign--in former East Germany a ministerial instruction had advised mothers not to let infants sleep on prone position. Historically, the promotion of infants sleeping on prone position seems to have been a tragic break of tradition in the western world in between 1970 and 1990, as infants had been put to sleep almost only on their back during the past centuries. If we compare East and West Germany concerning the influence on the ways of looking after infants since the 1960th of the last century it has become clear that the advice of medical authorities mainly effects the way of nursing regardless of the political system. More and more, paediatricians, gynaecologists, midwives and children's nurses should become aware of this responsibility.

Cross-Sectional Studies↗

PubMed2003

Surface electromyographic analysis of exercises for the trapezius and serratus anterior muscles.

STUDY DESIGN: This study used a prospective, single-group repeated-measures design to analyze differences between the electromyographic (EMG) amplitudes produced by exercises for the trapezius and serratus anterior muscles. OBJECTIVE: To identify high-intensity exercises that elicit the greatest level of EMG activity in the trapezius and serratus anterior muscles. BACKGROUND: The trapezius and serratus anterior muscles are considered to be the only upward rotators of the scapula and are important for normal shoulder function. Electromyographic studies have been performed for these muscles during active and low-intensity exercises, but they have not been analyzed during high intensity exercises. METHODS AND MEASURES: Surface electrodes recorded EMG activity of the upper, middle, and lower trapezius and serratus anterior muscles during 10 exercises in 30 healthy subjects. RESULTS: The unilateral shoulder shrug exercise was found to produce the greatest EMG activity in the upper trapezius. For the middle trapezius, the greatest EMG amplitudes were generated with 2 exercises: shoulder horizontal extension with external rotation and the overhead arm raise in line with the lower trapezius muscle in the prone position. The arm raise overhead exercise in the prone position produced the maximum EMG activity in the lower trapezius. The serratus anterior was activated maximally with exercises requiring a great amount of upward rotation of the scapula. The exercises were shoulder abduction in the plane of the scapula above 120 degrees and a diagonal exercise with a combination of shoulder flexion, horizontal flexion, and external rotation. CONCLUSION: This study identified exercises that maximally activate the trapezius and serratus anterior muscles. This information may be helpful for clinicians in developing exercise programs for these muscles.

Adult↗

PubMed2005

Prone versus supine position in mechanically ventilated children: a pilot study.

BACKGROUND: It is known that mechanically ventilated patients in the prone position have improved oxygenation compared with those supine. We did a prospective, randomized, controlled trial to evaluate the effect of prone position during mechanical ventilation, on survival in critically ill children. MATERIAL/METHODS: Forty-two children needing mechanical ventilation for various illnesses were randomized to receive initial ventilation for four hours prone or supine by drawing lots. Initial severity of illness and blood gases in all children were noted. In a crossover design, after the initial four hours the children were turned over and ventilated in the alternate posture for an hour. Oxygenation parameters and mean airway pressures were noted at one hour, four hours, and five hours. Mortality, duration of ventilation, and the above parameters were compared in the two groups. RESULTS: Initial PRISM scores were similar in the two groups. Mortality in the prone group was less than in the supine group. The odds ratio of mortality was 0.20 (95% CI 0.05-0.75). Duration of ventilation was similar in the two groups. The oxygenation index was significantly lower in the prone group at one, four, and five hours after onset of ventilation. CONCLUSIONS: Prone position in the first few hours of ventilation significantly improves gas exchange and oxygenation, reduces the mean airway pressures required to ventilate children, and may cause significant improvement in survival. Our study protocol allowed ventilator settings to be changed as needed during ventilation.

Child, Preschool↗

PubMed1977

Upper extremity lymphangiography in the radiation therapy of lymphomas and carcinoma of the breast.

Seventeen bilateral upper extremity lymphangiograms were obtained in patients with lymphoma referred for radiation therapy. The projection of the opacified axillary nodes is analyzed when using the mantle technique in various positions. The position of the lymph nodes varies considerably in the supine and prone positions. Placing pads underneath the shoulders in the prone position allows for better protection of the pulmonary parenchyma while still including the opacified lymph nodes. Because these nodes vary in position, it is recommended that if the axillary nodes are clinically involved or if hilar adenopathy is present, upper extremity lymphangiograms should be obtained to ensure inclusion of all the axillary lymph nodes. In treating carcinoma of the intact breast, care should be taken to include the lower axillary nodes in the tangenital breast field and to include 2 cm of lung in the posterior axillary boost.

Arm↗

PubMed2004

Sudden unexplained infant death in 20 regions in Europe: case control study.

BACKGROUND: After striking changes in rates of sudden unexplained infant death (SIDS) around 1990, four large case-control studies were set up to re-examine the epidemiology of this syndrome. The European Concerted Action on SIDS (ECAS) investigation was planned to bring together data from these and new studies to give an overview of risk factors for the syndrome in Europe. METHODS: We undertook case-control studies in 20 regions. Data for more than 60 variables were extracted from anonymised records of 745 SIDS cases and 2411 live controls. Logistic regression was used to calculate odds ratios (ORs) for every factor in isolation, and to construct multivariate models. FINDINGS: Principal risk factors were largely independent. Multivariately significant ORs showed little evidence of intercentre heterogeneity apart from four outliers, which were eliminated. Highly significant risks were associated with prone sleeping (OR 13.1 [95% CI 8.51-20.2]) and with turning from the side to the prone position (45.4 [23.4-87.9]). About 48% of cases were attributable to sleeping in the side or prone position. If the mother smoked, significant risks were associated with bed-sharing, especially during the first weeks of life (at 2 weeks 27.0 [13.3-54.9]). This OR was partly attributable to mother's consumption of alcohol. Mother's alcohol consumption was significant only when baby bed-shared all night (OR increased by 1.66 [1.16-2.38] per drink). For mothers who did not smoke during pregnancy, OR for bed-sharing was very small (at 2 weeks 2.4 [1.2-4.6]) and only significant during the first 8 weeks of life. About 16% of cases were attributable to bed-sharing and roughly 36% to the baby sleeping in a separate room. INTERPRETATION: Avoidable risk factors such as those associated with inappropriate infants' sleeping position, type of bedding used, and sleeping arrangements strongly suggest a basis for further substantial reductions in SIDS incidence rates.

Alcohol Drinking↗

PubMedDate not supplied

Simultaneous measurement of intraosseous and cerebrospinal fluid pressures in lumbar region.

Intraosseous pressure (IOP) and cerebrospinal fluid pressure (CSFP) in the lumbar region were measured simultaneously in two groups of patients with either spinal canal stenosis or disc herniation, to compare dynamic changes with positional changes, and to learn whether these pressure changes may have some role in the onset of claudication. IOP and CSFP showed almost the same change patterns with positional changes in two groups. They were lowest in the prone position and highest at the standing position. In standing with flexion, they were almost the same as in the prone position, but in extension they increased above the standing pressure. These dynamic pressure changes could act as a compression force to the cauda equina in the patient with spinal canal stenosis.

Adult↗

PubMed2006

Effect of prone and supine position on sleep, apneas, and arousal in preterm infants.

OBJECTIVE: Prematurely born compared with term born infants are at increased risk of sudden infant death syndrome, particularly if slept prone. The purpose of this work was to test the hypothesis that preterm infants with or without bronchopulmonary dysplasia being prepared for neonatal unit discharge would sleep longer and have less arousals and more central apneas in the prone position. METHODS: This was a prospective observational study in a tertiary NICU. Twenty-four infants (14 with bronchopulmonary dysplasia) with a median gestational age of 27 weeks were studied at a median postconceptional age of 37 weeks. Video polysomnographic recordings of 2-channel electroencephalogram, 2-channel electro-oculogram, nasal airflow, chest and abdominal wall movements, limb movements, electrocardiogram, and oxygen saturation were made in the supine and prone positions, each position maintained for 3 hours. The duration of sleep, sleep efficiency (total sleep time/total recording time), and number and type of apneas, arousals, and awakenings were recorded. RESULTS: Overall, in the prone position, infants slept longer, had greater sleep efficiency (89.5% vs 72.5%), and had more central apneas (median: 5.6 vs 2.2), but fewer obstructive apneas (0.5 vs 0.9). The infants had more awakenings (9.7 vs 3.5) and arousals per hour (13.6 vs 9.0) when supine. There were similar findings in the bronchopulmonary dysplasia infants. CONCLUSIONS: Very prematurely born infants studied before neonatal unit discharge sleep more efficiently with fewer arousals and more central apneas in the prone position, emphasizing the importance of recommending supine sleeping after neonatal unit discharge for prematurely born infants.

Arousal↗

PubMed1992

[Favourite sleeping positions among infants in the county of Roskilde. Is there a connection with sudden, unexplained infant death?].

The purpose of this study was to investigate the distribution of the favourite sleeping positions and other possible risk factors for SIDS among infants in a Danish county, and to compare the distribution af sleeping positions with the sleeping positions reported in SIDS-cases from the same district. Information about favourite sleeping positions at the age of one month and four months was collected by interviews with parents, performed consecutively by health visitors at the routine examinations of 174 infants aged eight months. Information about sex, birthweight, gestational age, complications of delivery, mother's age and maternal smoking in pregnancy was collected for each child from the Birth Registration form. Thirty-two SIDS-cases from the 10 year period 1982-91, mostly based on police reports, were analysed retrospectively as regards sleeping positions and other possible risk factors. The distribution of different sleeping positions at the age of one month/four months was: prone 59%/52%, lateral 39%/41%, supine 2%/6%. There was a significant negative correlation between birthweight and use of the prone position. Among the SIDS-cases, the prone sleeping position was reported in 18 of 21 cases (86%), where this information was available. In conclusion, the prone sleeping position seemed to be associated with an increased risk of SIDS (estimated OR 4.1) but some of this difference can be accounted for by the more frequent use of this position among children with low birthweight and other risk factors.

Denmark↗

PubMedDate not supplied

Mechanical ventilation in the management of acute respiratory distress syndrome.

The occurrence of acute respiratory distress syndrome (ARDS), is now common in intensive care units throughout the world. The diagnosis of ARDS is based on a definition that includes bilateral pulmonary infiltrates on chest radiographs, impaired oxygenation, and the absence of clinical evidence of elevated left atrial pressure. ARDS is the clinical result of a group of diverse processes, which range from physical or chemical injury, to extensive activation of innate inflammatory response. All these processes damage the integrity of the alveolar-capillary barrier causing increased alveolar-capillary permeability and an influx of protein-rich fluid into the alveolar space. This alveolar flooding results in hypoxemia, inactivated surfactant, intrapulmonary shunt, and impaired alveolar ventilation. The treatment of acute respiratory distress syndrome is largely supportive in nature, keeping patients alive while allowing their lungs to heal, and minimizing further pulmonary insult. In 1994 the National Heart, Lung, and Blood Institute (NHLBI) established the ARDS Network for the conduct of clinical trials. This is a network, supported by the National Institutes of Health, that provided the infrastructure for well-designed, multicenter, randomized trials of therapies for ARDS. The first study from this group in 2001 produced landmark data demonstrating mortality improvements in ARDS with particular mechanical ventilation strategies. Specifically, low tidal volume mechanical ventilation was demonstrated to reduce mortality by 22%. Other strategies such as high positive end expiratory pressure and prone positioning have not been shown to reduce mortality. Clinicians who are involved in the care of patients with ARDS should have a basic understanding of mechanical ventilation and the evidence guiding the mechanical ventilation strategies of these patients. Until further evidence is published, providers should adopt the use of a volume and pressure limited approach to mechanical ventilation.

High-Frequency Ventilation↗

PubMed1995

Stimulation of the obturator nerve during extracorporeal shock wave lithotripsy.

This paper presents eigth patients with lithiasis of the lower third of the ureter that were treated by extracorporeal shock wave lithotripsy (ESWL). All the procedures were performed with a Dornier HM4 lithotriptor in the sitting position. In all cases clinical signs of stimulation of the obturator nerve were presented. Because of the continuing movement of the patient and the possibility of damage to the obturator nerve, the lithotripsy was interrupted in the sitting position and was performed successfully with patients in the prone position. One possible explanation for the above phenomenon is that the increased abdominal pressure in the sitting position pushes the ureter with the stone towards the side walls of the pelvis and the obturator nerve. In this way, both obturator nerve and stone were included either in the zone of the high concentration of the shock waves, or in the secondary focal point, with the final result of stimulation of the nerve. By placing the patient into the prone position, the abdominal pressure is reduced, the ureter moves towards the center line, the obturator nerve gets away from the shock waves and the ESWL is completed freely without stimulation of the nerve.

Adult↗