Increased intra-abdominal pressure(IAP) might influence on perioperative morbidity related to increased CVP, PVWP, SVR, PAP and decreased venous return and cardiac output. Prone position has been known to increase IAP. In clinical field, various apparatuses has developed to minimize IAP elevation during prone position operation. In this study, we would compare the changes of IAP and respiratory system compliance according to positional apparatus in prone position.
In clinical field, Wison frame, chest rolls and Jackson table have been widely used for prone position surgery. Among those apparatus, Jackson table has padded supports under the chest and pelvis, so that the abdomen can hang freely and prevent the abdominal compression. By reducing abdominal and thoracic pressure, Jackson table would reduce blood loss, and less effects on pulmonary mechanics. But few studies has known to compare IAP with other positioning apparatus such as Wilson frame or chest roll.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
SUPPORTIVE_CARE
Masking
NONE
Enrollment
138
After standard total intravenous anesthesia using propofol and remifentanil continous infusion, patients were turned to the prone position on a Jackson table with two padded supports on each side. The supports were positioned under the lateral chest and at the iliac crest.
After standard total intravenous anesthesia using propofol and remifentanil continous infusion, patients were turned to the prone position on a Wilson frame. The supports were positioned vertically from shoulder to iliac crest.
After standard total intravenous anesthesia using propofol and remifentanil continous infusion, patients were turned to the prone position on a chest roll. The supports were positioned vertically from shoulder to iliac crest.
Seoul National University of Hospital
Seoul, South Korea
RECRUITINGchanges of Intraabdominal presure (IAP)
Compare IAP changes from supine to prone according to the positional apparatus : Wilson frame, Chestrolls and Jackson table
Time frame: 5 minute after position change
Changes of IAP and total respiratory system comliance (Crs) accoridng to PEEP change
Compare IAP and Crs according to PEEP changes in each group. PEEP applied 0,3,6 and 9 cm H2O and recoding was done at 1min after PEEP change. Total respiratory system compliance (Crs) = TV/(Pplat-PEEP)
Time frame: 1min after PEEP change
changes of dead space ventilation after position change
After genearal anesthetic induction, arterial blood gas analyssis (ABGA)was done at supine position. And then the position was changed to prone. 5minutes after prone position change, ABGA repeated, and calculated the dead space ventilation at each point. Dead space ventilation (Vd/Vt) = \[PaCo2-PETCO2\]/PaCo2 Finally, we would compare changes of dead space ventilation after position change.
Time frame: 5 minute after prone position
Hemodynamic change
Check the hemodynamic changes according to PEEP change : 0,3,6 and 9 cmH2O
Time frame: 1min after PEEP change
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