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PubMed1995

[Changes of arterial oxygen tension in supine position during one-lung anesthesia].

BACKGROUND: One-lung ventilation during anesthesia (one-lung anesthesia) in patients under lateral decubitus position to help performing intra-thoracic surgical procedures was well known to have larger alveolar-to-arterial oxygen tension difference and lower arterial oxygen tension (PaO2) as compared to two-lung ventilation. In the present study, we investigate the changes of arterial oxygen tension in the supine position during one-lung anesthesia. METHODS: Forty-two patients of palmar hyperhidrosis, ASA class I-II, scheduled to receive bilateral transthoracic endoscopic sympathectomy were studied. After anesthetic induction (fentanyl, thiopental, and succinylcholine), a 35 (for female) or 37 (for male) French left-sided Robertshaw double-lumen endobronchial tube was intubated. Anesthesia was maintained with isoflurane 1.0-1.5% and 50% O2-N2O. They were changed to isoflurane 1.5-2.0% and 100% O2 during one-lung ventilation. Once the surgical operation is completed, they were changed to 100% O2 and two-lung ventilation. Arterial blood gases were measured at 4 phases: 5 min after endobronchial intubation (two-lung ventilation), 5 min after left one-lung ventilation, 5 min after right one-lung ventilation, and 5 min after accomplishing operation (two-lung ventilation). RESULTS: The results showed PaO2 were significantly lower in left and right one-lung ventilation with 100% O2 as compared with that obtained from two-lung ventilation with 50% O2 5 min after endobronchial intubation (p < 0.05). Furthermore, right one-lung ventilation had a lower PaO2 than left one-lung ventilation (p < 0.05). CONCLUSIONS: We conclude that arterial oxygen tension can be safely maintained during one-lung anesthesia with pure oxygen in healthy patients lying in a supine position.

Adolescent↗
PubMed1992

Gas exchange in dogs in the prone and supine positions.

To determine the cause of the difference in gas exchange between the prone and supine postures in dogs, gas exchange was assessed by the multiple inert gas elimination technique (MIGET) and distribution of pulmonary blood flow was determined using radioactively labeled microspheres in seven anesthetized paralyzed dogs. Each animal was studied in the prone and supine positions in random order while tidal volume and respiratory frequency were kept constant with mechanical ventilation. Mean arterial PO2 was significantly lower (P less than 0.01) in the supine [96 +/- 10 (SD) Torr] than in the prone (107 +/- 6 Torr) position, whereas arterial PCO2 was constant (38 Torr). The distribution of blood flow (Q) vs. ventilation-to-perfusion ratio obtained from MIGET was significantly wider (P less than 0.01) in the supine [ln SD(Q) = 0.75 +/- 0.26] than in the prone position [ln SD (Q) = 0.34 +/- 0.05]. Right-to-left pulmonary shunting was not significantly altered. The distribution of microspheres was more heterogeneous in the supine than in the prone position. The larger heterogeneity was due in part to dorsal-to-ventral gradients in Q in the supine position that were not present in the prone position (P less than 0.01). The decreased efficiency of oxygenation in the supine posture is caused by an increased ventilation-to-perfusion mismatch that accompanies an increase in the heterogeneity of Q distribution.

Animals↗
PubMed1996

[Bicycle exercise echocardiography in the supine position: a simple and effective study method for the detection and localization of myocardial ischemia by the first consulted cardiologist].

Exercise echocardiography is increasingly used as an investigative technique, now that dynamic images can be captured digitally. Its equivalent reliability compared to scintigraphic methods has been demonstrated in a hospital setting. This study is an attempt to analyse its impact in daily practise. Standardized progressive stress was provided by bicycle ergometry in a supine position. Echocardiographic images of complete cardiac cycles were obtained in standard apical and parasternal short axial views before, during and after maximum effort and digitized for simultaneous analysis of synchronized images at rest and during exercise. 279 patients were studied (231 men, 48 women, mean age 61 +/- 10 years). Image quality was suboptimal in four cases. In the remaining 275 cases, ischemia was detected in 125 cases, the test was negative in 141 cases and doubtful in nine cases. Control by selective coronary angiography, as motivated by the clinical situation, was performed in 72 cases. In this particular group, exercise echocardiography showed 89% sensitivity, which is significantly higher than the figure of 63% recorded for conventional exercise testing (p < 0.0001). Exercise echocardiography by bicycle ergometer in a supine position is a valid, noninvasive investigative technique which can be used in an outpatient situation (feasibility 95%), since it is available on the spot. Its value appears greatest in cases where exercise ECG was not conclusive. A negative result enables the first consulted cardiologist to reassure the patient immediately, the favourable prognostic value of such a result having been demonstrated in the literature.

Adult↗
PubMed2005

Comparison of lung area by chest radiograph, with estimation of lung volume by helium dilution during prone and supine positioning in mechanically ventilated preterm infants: a pilot study.

Measurement of lung volume may be useful in determining the degree of lung disease and for optimizing an infant's mechanical ventilator settings. A chest radiograph (CXR) is often used to estimate lung volume, because direct measurement, e.g., functional residual capacity (FRC), is neither practical nor possible in the neonatal intensive care unit. In supinely positioned infants, good correlation was found between lung area determined by CXR and lung volume, e.g., functional residual capacity (FRC). Whether this is true for the prone position is unknown. Since positioning may affect oxygenation and pulmonary function, we studied the relationship between lung area measured from CXR and FRC during both supine and prone positioning in 14 mechanically ventilated preterm infants. Lung area was determined from CXRs using computed radiography and FRCs obtained by helium dilution at end-expiration in both supine and prone positions. Reproducibility of lung area measurements was demonstrated by high correlations between two observers (R2 = 0.92 and 0.99 for supine and prone, respectively). When supine, lung area was 15.4 +/- 3.1 cm2, and FRC was 19.5 +/- 7.3 ml. In prone position, lung area was 16.7 +/- 4.2 cm2, and FRC 23.0 +/- 9.4 ml. There was a moderate to strong positive correlation between lung area and FRC for both positions (supine: r = 0.57, P < 0.03; prone: r = 0.63, P < 0.02). Lung area measured by computed radiography is a reproducible and practical method for estimating lung volume from routine chest X-rays in both supine and prone positions in mechanically ventilated preterm infants.

Female↗
PubMed2003

Sciatic nerve blockade in the supine position: a novel approach.

PURPOSE: Sciatic nerve block is useful for surgery below the knee both intra- and postoperatively. Several techniques to insert a catheter at the knee level or higher have been described but need mobilization (lateral decubitus) of the patient. We describe novel landmarks, using a high lateral approach, to block the sciatic nerve without moving the patient. CLINICAL FEATURES: One hundred seven ASA I, II and III ASA patients scheduled for major foot or ankle surgery were studied prospectively. With patients awake and lying in the supine position, the catheter was introduced along novel landmarks in the peri-nervous adipose space using specifically designed material and nerve stimulation (< 0.5 mA). After a negative test dose (1% lidocaine with 1/200.000 epinephrine), 10 mL of 0.5% bupivacaine and 10 mL of 2% lidocaine were injected. Thirty minutes after performance of the block, the cutaneous and dermatomal sensory blockade were assessed using cold and pinprick tests while motor block was assessed using a modified Bromage scale. Complications and incidents were recorded. The tibial and superficial peroneal nerve were always blocked, while the deep peroneal and postero-femoral cutaneous nerves were blocked in only 97% and 83% of the patients, respectively. Anesthesia, was always present in the dermatome L5 and in the S1 dermatome in 98% of the patients. No major incidents or complications were noted. Three catheters could not be inserted and the anesthestic solution was injected through the needle. CONCLUSION: The lateral technique for sciatic nerve anesthesia and catheter insertion allows patients to remain in the supine position for performance of the block and catheter insertion, and results in a high rate of homogeneous anesthesia and a low incidence of side effects.

Adult↗
PubMed2003

The influence of morphine on the absorption of paracetamol from various formulations in subjects in the supine position, as assessed by TDx measurement of salivary paracetamol concentrations.

The aim of this study was to determine the influence of the type of paracetamol formulation on the rate of absorption when subjects are in the supine position, with or without taking concomitant morphine. Two groups of healthy volunteers were used, who were in the fasting state and remained in the supine position during the study. One group took 1,500 mg of paracetamol on three occasions as conventional tablets, dispersible tablets or a suspension in a randomized crossover design. Seventeen saliva samples per subject were obtained (time zero to 360 min post-dose), which were then centrifuged and kept at -20 degrees C prior to analysis. The second group repeated the study following four doses of morphine syrup (10 mg 4 hourly) in the 12 h preceding paracetamol ingestion. In this phase of the study, paracetamol absorption from suspension was not investigated. A TDx assay was used to determine salivary paracetamol concentrations. The tmax for conventional tablets when taken concomitantly with morphine was 160 (+/- 81) min compared to 51 (+/- 58) min for subjects not taking morphine. For dispersible tablets the tmax in the morphine group was 14 (+/- 9) min compared to 15 (+/- 12) min without morphine. The results suggest that patients who are confined to bed and taking morphine will have an unacceptably long delay between taking conventional paracetamol tablets and the paracetamol reaching therapeutic plasma concentrations. Conversely, there is little effect on the absorption of dispersible paracetamol under the same conditions.

Absorption↗
PubMedDate not supplied

[Sleeping in the supine position in the ASL 11 region of Piemonte. Assessment of the efficacy of a promotional campaign].

OBJECTIVES: To record the prevalence of the sleeping position of sucklings living in the ASL 11-Regione Piemonte; to make an information campaign about the utility of sleeping in the supine position (most important protection factor against the SIDS); to find out its efficacy for a short or long time. METHODS: During the first two months of 2002 all the parents coming to the consulting rooms for the compulsory vaccinations of their 3 and 5 months old babies have been interviewed about the position of their babies during sleep. The same recording has been made in the first two months of 2003 and 2004. During 2002 various consciousness campaigns have been made, above all for medical operators of hospital nurseries and of Mother-and-Child Departments and Prevention Departments in ASL 11 area. RESULTS: Before the consciousness campaign the percentage of 3 months old sucklings sleeping in the supine position was 62,3% and 55% for the 5 months old suckings; after the campaign the percentage has grown to 77,4% for 3 months old sucklings and 74,5% for 5 months old sucklings during 2003 and during 2004 the percentage has grown to 80,3% and 74,2%, respectively. CONCLUSIONS: A simple and not expensive but capillary consciousness and information campaign addressed to medical operators has obtained valid and statistically relevant results in a short time.

Health Promotion↗
PubMed2001

Dyspnoea exaggerated in the supine position and during exertion--diagnostic challenge.

The case of dyspnoea, exaggerated when in the supine position and during exertion, as a result of severe weakness of the diaphragm is reported. The aim of the study was to present a rare case of idiopathic bilateral diaphragmatic paresis (BDP) and to describe all the diagnostic procedures necessary to perform differential diagnostics. In order to establish the final diagnosis, chest radiography, haemodynamic evaluation of the circulatory system, ultrasonography, ultrasonocardiography, measurement of transdiaphragmatic pressures, scintiscanning of the lungs, spirometry, analysis of arterial blood gases, computed tomography of the thorax and external stimulation of the phrenic nerve were performed. The measurement of transdiaphragmatic pressure was crucial to establish and confirm the diagnosis of BDP, as only a small difference in gastric and oesophageal pressures during tidal breathing and inspiratory efforts was recorded. As no cause of diaphragmatic paresis was found, the case was classified as idiopathic. The final diagnosis of non-trauma related bilateral diaphragmatic weakness was generally delayed. In the case of the described patient, dyspnoea, the main symptom he was suffering from, was supposed to result from his congenital heart defect. We recommend that the suspicion of idiopathic diaphragmatic paresis should always be raised in patients suffering from respiratory failure of unknown origin. It is, however, necessary to perform extensive diagnostics to exclude the other causes of phrenic-diaphragmatic impairment. It's also necessary to consider all infections, injuries and surgical procedures within the thorax as possible causes of diaphragmatic paresis.

Diagnosis, Differential↗
PubMed1989

[Changes in the cardiac dynamics in passive tile to the supine position--impedance cardiography measurements].

Passive tilt is an effective means to manipulate cardiodynamic processes. While there is a large amount of literature available concerning cardiac function with upright tilt, passive tilt into the supine position is poorly investigated. There is evidence that adapting processes to the new position do not show analogy in both conditions. In this study we investigated cardiodynamic changes occurring with passive-graded tilt from the upright position to 20 degrees headdown tilt. Twenty healthy students of both sexes participated in the study. Using impedance cardiography combined with phonocardiography it was possible to acquire stroke volume, heart rate, Heather index, and systolic time intervals. The whole procedure was repeated to test the reliability of impedance data. There was no steady augmentation of stroke volume. Between 90 degrees and 60 degrees stroke volume remained stable and showed only little change between 60 degrees and 30 degrees. Between 30 degrees and the supine position there was a steep increase of stroke volume. Tilting into the upright position apparently has a different effect. The onset of heart rate decline preceded the increase of stroke volume. It is concluded that only little changes of stroke volume/preload are necessary to induce vagal response. In the 30 degrees position both cardiac output and Heather index were minimal; this may be due to decreased sympathetic output. Systolic time intervals showed volume dependancy. Correlations between the first and second part of the study were high for all variables.

Adult↗
PubMed1987

Skin blood flow in relation to external pressure and temperature in the supine position on a standard hospital mattress.

The purpose of this investigation was to study the relationship between skin blood flow, external pressure and temperature in the skin over bony prominences and muscle padded areas, when healthy individuals and patients with hemiplegia were lying in the supine position on a standard hospital mattress. The pressure values under the gluteus maximus muscle and the sacrum increased significantly in the supine position with bent knees. The heels resting on the mattress gave very high pressure values. Some patients had no observable skin blood flow in the skin over the sacrum and the gluteus maximus muscle. In many individuals there was no observable blood flow in the skin over the heel among both healthy individuals and patients, which was confirmed by very high post-ischemic reactive hyperaemia. There is also a heat accumulation when lying on the mattress which increases the requirement for skin blood flow.

Adult↗
PubMed2007

Longterm treatment results of childhood medulloblastoma by craniospinal irradiation in supine position.

Medulloblastoma, a primitive neuroectodermal tumor growing in cerebellum, is one of the most sensitive to radiation therapy childhood brain tumors. The radiotherapy is an essential method of treatment for these tumours, but the surgery is the primary treatment of choice in medulloblastoma. I this study between January 1997 and March 2005 were post-operative irradiated a total number of 33 pediatric patients aged under 15 years (median age 8.7 years) with medulloblastoma. All tumors were histologically proved and were localizated infratentorially in the posterior fossa. All of the patients were irradiated with a dose of 24-36 Gy to the whole craniospinal axis and boost with conformal therapy restricted to the tumor bed to the total dose of 50-54 Gy (30-36 Gy "high risk", 24-30 Gy "standard risk" group). Chemotherapy received 26 patients (78%). Patients with craniospinal irradiation were placed in supine position and fixed by a vacuum-form body immobilizer and head mask. Irradiation was performed using standard fractionation (5 fractions per week) with a single dose of 1.5-1.8 Gy for craniospinal axis by photon beam (6 MV) of the linear accelerator. The median overall survival for the whole group was 55.3 months. The median of disease-free survival was 20.6 months, 8 patients (24%) died. In our study the statistical difference in survival rate between standard and high-risk patients with medulloblastoma was not shown. No relationship was found between survival and age, sex or tumor size. Endocrine deficits occurred in 45% (8 patients of the group were hypothyroid, 6 patients needed growth hormone replacement therapy, 1 patient had early puberty). This results (results of overall and disease-free survival) and side-effects of technique of craniospinal axis irradiation in supine position are comparable with results of technique in prone position. Further evaluation of the effectiveness of our therapy is not feasible due to the small number of patients.

Cerebellar Neoplasms↗
PubMed2001

Supine position decreases the ability of the nose to warm and humidify air.

We tested the hypothesis that decreasing nasal air volume (i.e., increasing nasal turbinate blood volume) improves nasal air conditioning. We performed a randomized, two-way crossover study on the conditioning capacity of the nose in six healthy subjects in the supine and upright position. Cold, dry air (CDA) was delivered to the nose via a nasal mask, and the temperature and humidity of air were measured before it entered and after it exited the nasal cavity. The total water gradient (TWG) across the nose was calculated and represents the nasal conditioning capacity. Nasal volume decreased significantly from baseline without changing the mucosal temperature when subjects were placed in the supine position (P < 0.01). TWG in supine position was significantly lower than that in upright position (P < 0.001). In the supine position, nasal mucosal temperature after CDA exposure was significantly lower than that in upright position (P < 0.01). Our data show that placing subjects in the supine position decreased the ability of the nose to condition CDA compared with the upright position, in contrast to our hypothesis.

Adult↗
PubMed1981

Comparative echocardiographic examinations in sitting and supine position at rest and during dynamic exercise.

Echocardiograms of 12 healthy male subjects in the supine and sitting positions were obtained. The end-diastolic (EDD) and end-systolic (ESD) diameters of the left ventricle were measured, and the stroke volume was calculated as the cube of the diameter. A significantly (P less than 0.001) smaller stroke volume was found in the sitting rest position (67.1 ml) compared to the supine rest position (92.3 ml). During dynamic exercise, the stroke volume increase in the sitting position (29.7%) was considerably higher than in the supine position (13%). The shortening fraction showed no difference in the sitting and supine positions at rest and during dynamic exercise. The results demonstrate good agreement between the echocardiographic method and other noninvasive procedures.

Adult↗
PubMed1982

Systolic time intervals during isometric exercise in supine position should be corrected also for arterial pressure.

In this paper we have studied the relationship between the systolic time intervals (STI) and the heart rate (HR) and systolic arterial pressure (SAP) in a group of 24 healthy subjects at three different effort levels during an isometric exercise in supine position and in basal conditions. We observed a decrease of the non corrected STI values during the exercise. Then we corrected STI using the regression equations obtained by plotting STI values versus the corresponding HR values at rest and during the exercise. We showed an increase of corrected left ventricular ejection time (LVET) during the whole exercise, and an increase of corrected total electromechanical systole (QS2c) at 50% effort level and then a return to the basal values. We also derived the multiple regression equations correlating QS2 and LVET with HR and SAP. Notwithstanding these equations show a significant positive correlation between the two STI considered and SAP only at the maximum effort, we corrected LVET and QS2 values by these equations assuming that the relationship between these parameters exists also in basal conditions and during the remaining stages of the exercise. By this correction we found a decrease of LVETc and QS2c in accordance with hemodynamic data reported by other authors. We may conclude that it seems useful to correct the STI obtained during isometric exercise in supine position both for HR and SAP.

Adult↗
PubMed1991

Leg movements in the supine position of infants with spastic diplegia.

Leg movements in the supine position of 49 infants with spastic diplegia (three to 11 months corrected age) were examined. Only simultaneous flexion and extension of the hips and knees were seen, with exceptional isolated hip movements; the simultaneous movements had synergic features. When the knees were flexed, the hips were flexed, abducted and externally rotated, and the ankles were dorsiflexed. When the knees were extended, the hips were extended, adducted and internally rotated and the ankles were plantar-flexed. Hip flexion combined with knee extension (leg elevation) and isolated knee movements were not seen in diplegic infants, but were seen in all control preterm infants with a good prognosis, after five and six months corrected age, respectively. The absence of these movements is a useful diagnostic item for spastic diplegia.

Cerebral Palsy↗
PubMed2000

Emergence from anesthesia in the prone versus supine position in patients undergoing lumbar surgery.

BACKGROUND: Conventional supine emergence in patients undergoing prone lumbar surgery frequently results in tachycardia, hypertension, coughing, and loss of monitoring as the patient is rolled supine. The prone position might facilitate a smoother emergence because the patient is not disturbed. No data describe this technique. METHODS: Fifty patients were anesthetized with fentanyl, nitrous oxide, isoflurane, and rocuronium. By the conclusion of surgery, all patients achieved spontaneous ventilation and full reversal of neuromuscular blockade in the prone position, as the volatile anesthetic level was reduced. Baseline heart rate and mean arterial pressure were recorded. Patients were then randomized at time 0 to the supine (n = 24) or prone (n = 21) position as 100% oxygen was administered. Patients in the supine position were then rolled over, while those in the prone position remained undisturbed. Heart rate, mean arterial pressure, and coughs were recorded until extubation. Tracheas were extubated on eye opening or purposeful behavior. RESULTS: When compared with the supine group, prone patients had significantly less increase in heart rate (P = 0.0003, maximum increase 9.3 vs. 25 beats/min), less increase in mean arterial pressure (P = 0.0063, maximum increase 4.8 vs. 19 mmHg), less coughing (P = 0.0004, 7.0 vs. 23 coughs), and fewer monitor disconnections (P < 0.0001). Time to extubation from time 0 was similar (4.0 vs. 3.7 min, prone vs. supine). No one required airway rescue. There was no significant difference in need for restraint (three prone, four supine). CONCLUSIONS: Prone emergence and extubation is associated with less hemodynamic stimulation, less coughing, and less disruption of monitors, without specifically observed adverse effects, when compared with conventional supine techniques.

Androstanols↗
PubMed2003

[An transcranial Doppler ultrasonography and X-ray study of cervical vertigo patients treated by manipulation in supine position].

OBJECTIVE: To observe the transcranial Doppler ultrasonography and X-ray changes of cervical vertigo patients caused by cervical instability before and after the manipulation treatment in supine position. METHODS: Sixteen cervical vertigo patients who underwent supine manipulation treatment were reviewed retrospectively. After the treatment, the changes of transcranial Doppler ultrasonography of cervical vertebral artery and X-ray of cervical spine were observed. RESULTS: Before the treatment, the mean blood flow velocity of vertebral artery was (48.6+/-3.1) cm/s, much higher than that of the normal group (P<0.05), the means of the horizontal displacement of C3,4 and C4,5 were (3.18+/-0.42) mm and (3.46+/-0.26) mm respectively. After the treatment, the blood flow velocity and the C3,4 horizontal displacement decreased significantly (P<0.05). The effective rate of the manipulation treatment was 100%. CONCLUSION: The manipulation treatment is an effective method for cervical vertigo patients caused by cervical instability, and the effect is correlated with the improvement of the blood flow of cervical artery and the restoration of cervical stability.

Adult↗