Abstract
PurposeA variety of hemodynamic and respiratory alterations accompany patients in the prone position; however the effect of the prone position on intraoperative cerebral saturation has not been studied. We sought to examine whether the incidence of cerebral oxygen desaturation in elderly patients (≥68 years of age) undergoing spine surgery in the prone position was more common than patients undergoing major surgery in the supine position.MethodsWe performed a retrospective cohort study of 205 patients; 63 patients underwent surgery in the prone position and 142 in the supine position. Patients were evaluated for cerebral desaturation with bilateral cerebral oximetry. The primary predictor was position, secondary were: length of the surgery, incidence and duration of cerebral desaturation episodes at several thresholds, average time of Bispectral index below threshold of 45 in minutes, average electroencephalogram suppression ratio >0, amount of blood transfused, and the incidence of hypotension and hypertension.ResultsElderly spine surgery patients in the prone position were more than twice as likely to experience mild cerebral desaturation as patients in the supine position. Patients in the prone position had longer surgeries; however cerebral desaturation in the prone position was significantly more common even when adjusted for surgery time and the occurrence of intraoperative hypotension.ConclusionCerebral desaturation is related to the prone position in elderly surgery patients. Future studies are necessary to determine whether this translates to a higher incidence of postoperative cognitive dysfunction and delirium.
Highlights
The prone position causes significant physiologic changes, its effect on cerebral physiology under anesthesia has not been well described [1]
The role of prone position relative to cerebral perfusion is subject to significant equipoise because studies in ICU patients suggest improvement in cerebral perfusion pressure in the prone position while studies of prone lumbar surgery have shown a decrease in MAP which might predispose toward cerebral desaturation [2,3,4]
Several small studies in general surgery patients have associated cerebral desaturation with postoperative cognitive dysfunction and longer PACU and hospital stays, none of these studies have examined the effect of the prone position [8,9]
Summary
The prone position causes significant physiologic changes, its effect on cerebral physiology under anesthesia has not been well described [1]. Cerebral oximetry is a noninvasive means of measuring the adequacy of brain oxygenation to the frontal lobes. It is currently used primarily in cardiac surgery, which is considered high risk for cerebral desaturation because of decreased cerebral perfusion on cardiopulmonary bypass [5,6,7]. Several small studies in general surgery patients have associated cerebral desaturation with postoperative cognitive dysfunction and longer PACU and hospital stays, none of these studies have examined the effect of the prone position [8,9]
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