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Profound intraoperative metabolic acidosis and hypotension in a child undergoing multilevel spinal fusion

Mohanad Shukry1, Jonathan A D'Angelo, Minal Joshi

  • 1Department of Anesthesiology, The Children's Hospital, University of Oklahoma Health Sciences Center, 750 North East 13th Street, Suite 200, Oklahoma City, OK 73104, USA.

Case Reports in Medicine
|October 21, 2009
PubMed

Insights

Prone positioning during spinal surgery can cause dangerous hypotension due to abdominal compression and anesthesia effects. Returning patients to the supine position is crucial for stabilizing cardiovascular function.

Area of Science:

  • Anesthesiology
  • Cardiovascular Physiology
  • Surgical Positioning

Background:

  • The prone position is frequently used for spinal surgery but may lead to cardiovascular depression.
  • Mechanisms and effective preemptive strategies for prone-position-induced hypotension remain incompletely understood.

Observation:

  • A case of persistent hypotension and acidosis during spinal surgery in the prone position is presented.
  • Hypotension and acidosis were refractory to standard interventions, including fluid resuscitation and vasopressors.

Findings:

  • Prolonged abdominal compression in the prone position can impede venous return, increasing blood loss and decreasing cardiovascular reserve.
  • Total intravenous anesthesia (TIVA) may blunt sympathetic responses more than inhalation anesthesia, exacerbating hypotension.
  • The patient's condition improved significantly only after repositioning to the supine position.

Implications:

  • Careful patient monitoring and consideration of positioning-related risks are essential during prone spinal surgery.
  • Differential diagnoses for refractory hypotension in this setting should include abdominal compression and its sequelae.
  • Understanding these mechanisms can guide the development of preemptive measures to mitigate cardiovascular risks associated with prone positioning.

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