Cerebral Oxygenation Under General Anesthesia Can Be Safely Preserved in Patients in Prone Position: A Prospective Observational Study.
BACKGROUND
The effects of prone position (PP) on cerebral tissue metabolism are not well known. The aim of this investigation was to evaluate regional cerebral oxygen desaturation in patients undergoing lumbar spine surgery in PP during routine anesthesia management.


METHODS
Between July 2013 and October 2013, 50 consecutive patients undergoing lumbar spine surgery under general anesthesia in PP were enrolled. The anesthetic technique was standardized. Using near-infrared spectroscopy, bilateral regional cerebrovascular oxygen saturation was recorded during the surgery.


RESULTS
After 30 and 60 minutes of prone repositioning, significant decreases in bilateral regional cerebral oxygen saturation were observed compared with the values in the supine position (from 76.24% to 73.18% at 30 min and 72.76% at 60 min on the right side and from 77.06% to 73.76% at 30 min and 72.92% at 60 min on the left side; P<0.05). These changes were not clinically important and returned to supine values after 90 minutes of prone positioning. Decreases in cerebral oxygen saturation were accompanied by reductions in heart rate and mean arterial pressure (P<0.05). Older age and higher perioperative risk had a significant effect on the reduction of cerebral oxygen values (P<0.05).


CONCLUSIONS
The results of our study show that margin of safety against impaired cerebral oxygenation can be maintained in PP. Preventing bradycardia and arterial hypotension is crucial. Older patients and those at higher perioperative risk need more meticulous attention.
*Brain and Spinal Cord Injury Research Center, Neuroscience Institute §School of Public Health, Tehran University of Medical Sciences, Tehran, Iran †International Neuroscience Institute ‡Department of Anesthesiology, Intensive Care and Pain Management, Academic Teaching Nordstadt Hospital, Hannover, Germany.
Babak
B
Babakhani
Arash
A
Heroabadi
Narges
N
Hosseinitabatabaei
Martin
M
Schott
Saeed
S
Yekaninejad
Jan-Peter
JP
Jantzen
Jan-Hinrich
JH
Baumert
D000328:Adult; D000368:Aged; D000375:Aging / Q000378:metabolism; D000768:Anesthesia, General / Q000379:methods*; D062186:Arterial Pressure; D001921:Brain / Q000378:metabolism*; D005260:Female; D006339:Heart Rate; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood*; D016684:Prone Position; D011446:Prospective Studies; D019265:Spectroscopy, Near-Infrared; D013131:Spine / Q000601:surgery; D016683:Supine Position
D010100:Oxygen