[Hypotension after turning to the prone position].

Area of Science:

• Neurosurgery
• Anesthesiology
• Spinal Cord Medicine

Background:

• Hypotension following prone positioning is a recognized complication, especially in patients with cervical spinal lesions.
• Understanding the comparative incidence of hypotension in spinal versus brain lesion patients during prone positioning is crucial for patient safety.

Purpose of the Study:

• To compare the frequency of hypotension after prone positioning in patients with cervical spinal lesions versus brain lesions.
• To investigate the relationship between cervical spinal cord integrity and the occurrence of hypotension during prone surgery.

Main Methods:

• A retrospective study of 61 patients (ages 40-82, ASA grade 1-2) undergoing prone positioning surgery.
• Patients were divided into two groups: cervical laminoplasty (Group C, n=40) and craniotomy (Group B, n=21).
• Ephedrine administration for systolic blood pressure <80 mmHg was recorded; T2-weighted cervical cord MRI was analyzed for signal intensity changes.

Main Results:

• No significant differences in age or sex distribution between Group C and Group B.
• Group C (cervical lesion) showed more frequent ephedrine use compared to Group B (brain lesion), despite larger induction doses of propofol and fentanyl in Group B.
• High signal intensity areas on T2-weighted cervical cord MRI correlated with hypotensive events in Group C patients.

Conclusions:

• Patients with cervical spinal lesions are at a higher risk of developing hypotension during prone positioning.
• Damage to the sympathetic pathways in the cervical spinal cord can lead to autonomic dysfunction, necessitating vigilant monitoring.
• Strict intraoperative monitoring during prone positioning is critical for patients with cervical spinal lesions to prevent and manage hypotension.