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Trendelenburg positioning does not prevent a decrease in cardiac output after induction of anaesthesia with propofol

A Kardos1, C Földesi, A Nagy

  • 1Paediatric Intensive Care Unit, Heim Pál Children's Hospital, Ullöi Str. 89, 1086 Budapest, Hungary. dr.kardos@axelero.hu

Acta Anaesthesiologica Scandinavica
|August 2, 2006
PubMed
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Trendelenburg positioning did not improve cardiac performance in children after anesthesia induction with propofol and fentanyl. This head-down tilt maneuver did not enhance hemodynamic responses in pediatric patients.

Area of Science:

  • Pediatric Anesthesiology
  • Cardiovascular Physiology
  • Hemodynamic Monitoring

Background:

  • Anesthesia induction can decrease cardiac output and blood pressure.
  • Head-down tilt (Trendelenburg positioning) is a common intervention for hypotension.
  • Its effect on pediatric hemodynamics during anesthesia induction is not well-established.

Purpose of the Study:

  • To investigate the hemodynamic effects of Trendelenburg positioning.
  • To determine if Trendelenburg positioning modifies the response to propofol/fentanyl induction.
  • To assess cardiac performance in pediatric patients using impedance cardiography.

Main Methods:

  • Randomized single-center study in 30 ASA I children (7-16 years).
  • Propofol/fentanyl induction followed by 5 minutes of 20-degree head-down tilt (HDG) or no tilt (supine group, SG).

Related Experiment Videos

  • Impedance cardiography (ICG) monitored heart rate, blood pressure, cardiac index, and stroke volume index.

    • Main Results:

    • Both groups showed decreased cardiac index, mean arterial blood pressure, heart rate, and Heather index post-induction.
    • The head-down group had lower heart rate and higher stroke volume index at 3 minutes compared to the supine group.
    • No significant difference in cardiac index or systemic vascular resistance index was observed between groups post-induction.

    Conclusions:

    • Trendelenburg positioning does not improve cardiac performance following propofol/fentanyl anesthesia induction in children.
    • The hemodynamic response to anesthesia induction in pediatric patients is not significantly enhanced by head-down tilt.