Prone Versus Sitting Position in Neurosurgery-Differences in Patients' Hemodynamic Management

Area of Science:

• Anesthesiology
• Neurosurgery
• Critical Care Medicine

Background:

• Neurosurgery under general anesthesia can cause significant hemodynamic alterations.
• Patient positioning (sitting or prone) may influence these changes.

Purpose of the Study:

• To evaluate hemodynamic profiles during stroke volume-directed fluid administration in neurosurgery patients.
• To compare fluid administration and hemodynamic responses between sitting and prone positions.

Main Methods:

• Two prospective trials combined data from 58 patients (30 prone, 28 sitting).
• Patients received either Ringer acetate (RAC) or hydroxyethyl starch (HES) for stroke volume optimization.
• Two-way analysis of variance compared hemodynamic profiles and fluid consumption between positions and fluid types.

Main Results:

• Higher cumulative doses of RAC than HES were needed for comparable hemodynamics (P < 0.05).
• Weight adjustment eliminated the statistical difference in fluid consumption between fluid types.
• Fluid administration did not differ between prone and sitting positions.
• Sitting position showed lower mean arterial pressure but higher cardiac and stroke volume indices.

Conclusions:

• The sitting position does not necessitate greater fluid treatment than the prone position.
• HES demonstrated slightly greater efficacy than RAC, potentially due to patient weight differences.
• Goal-directed fluid administration and moderate vasoactive drug use ensure stable hemodynamics in both positions.