title: Trendelenburg positioning does not prevent a decrease in cardiac output after induction of anaesthesia with propofol in children.
abstract: OBJECTIVE
  Induction of anaesthesia may cause decreased cardiac output and blood pressure. Head-down tilt is often the first clinical step to treat hypotension. The objective of this randomized single centre study was to determine, with the use of impedance cardiography (ICG), whether Trendelenburg positioning modifies the haemodynamic response to propofol/fentanyl induction of anaesthesia in ASA I children.
  
  
  METHODS
  Thirty ASA I children aged between 7 and 16 years scheduled for elective minor orthopaedic surgery were included. After intravenous induction with propofol and fentanyl in the head-down group (HDG, n = 15), 5 min of 20 degrees head-down tilt was applied. In the supine group (SG, n = 15), no change in the supine position was made. Heart rate (HR), mean arterial blood pressure (MABP), end-tidal carbon dioxide (ETCO(2)), stroke volume index (SVI), cardiac index (CI), systemic vascular resistance index (SVRI) and Heather index (HI) were recorded before (B), at 3 (A(3)), 5 (A(5)) and 8 (A(8)) minutes after induction in each group.
  
  
  RESULTS
  After induction, a significant decrease in CI, MABP, HR and HI was recorded in both groups. In the study group, significantly lower values of HR (66 vs. 78 beat/min) and higher values of SVI (42.9 vs. 40.6 ml/min/m(2)) were measured at A(3) compared with the control group. After induction, no difference in CI and SVRI was found between the two groups.
  
  
  CONCLUSIONS
  The present study shows that cardiac performance is not improved by Trendelenburg positioning after propofol/fentanyl induction of anaesthesia in children.
authors.affiliation: Paediatric Intensive Care Unit, Heim Pál Children's Hospital, Ullöi Str. 89, 1086 Budapest, Hungary. dr.kardos@axelero.hu
authors.forename: A
authors.initials: A
authors.lastname: Kardos
authors.forename: C
authors.initials: C
authors.lastname: Földesi
authors.forename: A
authors.initials: A
authors.lastname: Nagy
authors.forename: A
authors.initials: A
authors.lastname: Sáringer
authors.forename: A
authors.initials: A
authors.lastname: Kiss
authors.forename: G
authors.initials: G
authors.lastname: Kiss
authors.forename: P
authors.initials: P
authors.lastname: Marschalkó
authors.forename: M
authors.initials: M
authors.lastname: Szabó
mesh_terms: D000293:Adolescent; D000771:Anesthesia, Intravenous; D018686:Anesthetics, Intravenous; D001794:Blood Pressure; D001944:Breath Tests; D002245:Carbon Dioxide / Q000032:analysis; D002302:Cardiac Output; D002307:Cardiography, Impedance; D002648:Child; D005260:Female; D005283:Fentanyl; D018475:Head-Down Tilt; D006339:Heart Rate; D006801:Humans; D008297:Male; D019637:Orthopedic Procedures; D015742:Propofol; D013318:Stroke Volume; D014655:Vascular Resistance
chemical_list: D018686:Anesthetics, Intravenous; D002245:Carbon Dioxide; D005283:Fentanyl; D015742:Propofol