title: Neurosurgery in the sitting position: retrospective analysis of 692 adult and pediatric cases.
abstract: OBJECTIVE
  The sitting position is routinely used in many centers, although its use remains controversial and appears to be diminishing because of the risk of venous air embolism (VAE).
  
  
  METHODS
  This is a retrospective analysis of 601 adult and 91 pediatric cases underwent neurosurgery from January 1995 through December 2010 in the sitting position. The incidence of VAE and other complications related to the sitting position has been determined. VAE was defined as a sudden and sustained decrease of end-tidal carbon dioxide (ETCO2) ≥0.7 kPa.
  
  
  RESULTS
  The incidence of VAE in children and adults were found to be 26.3% (n=24) and 20.4% (n=123) consecutively but the difference was not significant. The incidence of positioning induced hypotension was more in adults (37.6%) compared to children (18.6%, p=0.00001). The presence of COPD (p=0.04) and ASA status (p=0.03) showed a correlation with 'hypotension with positioning'. There was no peroperative mortality.
  
  
  CONCLUSIONS
  The study provides a significant body of data on neuroanesthesia for the sitting position and our results suggest that if the sitting position is a neurosurgical necessity it can be used with vigilant follow up throughout the procedure to detect any occurrence of VAE by ETCO2 monitoring if you do not have the chance to use more sensitive tools.
authors.affiliation: Istanbul University, Cerrahpasa Faculty of Medicine, Department of Anesthesiology and Intensive Care, 34098 Istanbul, Turkey.
authors.forename: Ozlem Korkmaz
authors.initials: OK
authors.lastname: Dilmen
authors.forename: Eren Fatma
authors.initials: EF
authors.lastname: Akcil
authors.forename: Ercan
authors.initials: E
authors.lastname: Tureci
authors.forename: Yusuf
authors.initials: Y
authors.lastname: Tunali
authors.forename: Mois
authors.initials: M
authors.lastname: Bahar
authors.forename: Taner
authors.initials: T
authors.lastname: Tanriverdi
authors.forename: Sabri
authors.initials: S
authors.lastname: Aydin
authors.forename: Ercument
authors.initials: E
authors.lastname: Yentur
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D018681:Anesthetics, General / Q000008:administration & dosage / Q000009:adverse effects; D002245:Carbon Dioxide / Q000378:metabolism; D002550:Cerebral Veins / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D004618:Embolism, Air / Q000453:epidemiology* / Q000503:physiopathology* / Q000517:prevention & control; D005260:Female; D006801:Humans; D007024:Hypotension, Orthostatic / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control; D007431:Intraoperative Complications / Q000453:epidemiology* / Q000503:physiopathology* / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects* / Q000379:methods / Q000706:statistics & numerical data; D056888:Patient Positioning / Q000009:adverse effects* / Q000379:methods / Q000706:statistics & numerical data; D011187:Posture / Q000502:physiology; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control; D012143:Respiratory Physiological Phenomena; D012189:Retrospective Studies; D013990:Tidal Volume / Q000502:physiology
chemical_list: D018681:Anesthetics, General; D002245:Carbon Dioxide