The sitting position in neurosurgical operations. Results of a survey

Abstract

In February 1995 a questionnaire was sent out on perioperative management during neurosurgical operations performed in the sitting position to 136 centres and hospitals within the Federal Republic of Germany that perform neuroanaesthesia. The response rate was 61.02%. Besides the question of perioperative monitoring during neurosurgical operations in the sitting position, we asked about currently used positions for patients during the following neurosurgical operations:posterior fossa, craniospinal and posterior cervical surgery. Of all centres, 32.9% use the sitting position only for posterior fossa and craniospinal surgery. For posterior cervical surgery the sitting and prone positions are favoured by 25.6% of all clinics. Nonspecific basic monitoring (electrocardiogram, pulse oximetry, central venous pressure, invasive or noninvasive arterial pressure) is an accepted standard in all clinics. Capnometry, as a specific monitor for venous air embolism, is used in all centres (100%). Precordial Doppler ultrasound (US) monitoring is used in 69.2% of all clinics; 3.8% use transoesophageal Doppler US as a diagnostic method for venous air embolism. The sitting position is the preferred position for posterior fossa and craniospinal surgery in neurosurgical patients in Germany. For posterior cervical surgery the German centres use both the sitting and prone positions. Alternative positions like the lateral or the "park-bench" positions are hardly ever used. The essential monitoring devices for neurosurgical operations in the sitting position, as recommended after the survey by the German Society for Anaesthesiology and Intensive Care Medicine (DGAI) in 1995, are predominantly used. However, the use of Doppler US (precordial or transoesophageal) for the detection of venous air embolism and the preoperative diagnosis of a persistent foramen ovale is not yet widespread. To determine the effect of the recommendations by the DGAI on clinical practice, the survey will be repeated in 1997.