title: A streamlined protocol for the use of the semi-sitting position in neurosurgery: a report on 48 consecutive procedures.
abstract: The semi-sitting position has lost favor among neurosurgeons partly due to unproven assumptions of increased complications. Many complications have been associated with this position; the most feared: venous air embolism and paradoxical air embolism. We report on this retrospective study of the outcome over 4 years of 48 neurosurgical patients operated on consecutively using a standardized protocol: 41 (85%) in the semi-sitting position, and seven (15%) in the prone position. Procedures included: tumor resection (34), posterior fossa decompression (12), cyst resection (1) and resection of arteriovenous malformation (1). Pre-operative workup was standardized. Vigilant intra-operative observation was done by an experienced neuroanesthetist. Pertinent data was extracted from surgical records. Of the 48 patients, 10 (20.8%) were found to have a patent foramen ovale (PFO) on trans-esophageal echocardiography. Of these, four (40%) patients underwent procedures in the semi-sitting position while six (60%) did not. A clinically significant venous air embolism (VAE) was detected during 2 of the 41 semi-sitting procedures (4.9%). Neither patient suffered any obvious sequelae. No other morbidity was encountered associated with surgical position. Our study suggests that a model similar to ours is effective in preventing major complications associated with the semi-sitting position. The semi-sitting position is a safe, practical position that should be considered in appropriate cases. The fear of dreadful complications seems unwarranted.
authors.affiliation: Department of Neurosurgery, The Ohio State University, Columbus, OH 43210, USA. Mario.Ammirati@osumc.edu
authors.forename: Mario
authors.initials: M
authors.lastname: Ammirati
authors.forename: Tariq Theeb
authors.initials: TT
authors.lastname: Lamki
authors.forename: Andrew Brian
authors.initials: AB
authors.lastname: Shaw
authors.forename: Braxton
authors.initials: B
authors.lastname: Forde
authors.forename: Ichiro
authors.initials: I
authors.lastname: Nakano
authors.forename: Matharbootham
authors.initials: M
authors.lastname: Mani
mesh_terms: D001927:Brain Diseases / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D019635:Neurosurgical Procedures / Q000379:methods*; D019990:Perioperative Care; D011187:Posture / Q000502:physiology; D012189:Retrospective Studies