Effect Of Lateral Decubitus Position Research Articles

Comparison of the early results of the treatment of developmental dysplasia of hip with the lateral approach and the posterior lateral approach total hip arthroplasty

Objective To investigate the early clinical effect of lateral decubitus position direct anterior approach(DAA) for primary total hip arthroplasty(THA) in the treatment of developmental dysplasia of hip(DDH). Methods A retrospective study was performed on 56 cases of DDH patients who were admitted from September 2015 to September 2016.According to different approaches, patients were divided into the DAA group(n=28) and the posterolateral approach(PLA) group(n=28). The follow-up time ranged from 7 to 15 months(average 9.2 months). Statistics of the two groups with incision length, operative time, intraoperative blood loss, postoperative drainage, total blood loss, ambulation time and hospitalization days, VAS pain score of 1, 3, 5, 7 days after operation, Harris hip score of 3, 7 days, 1, 3, 6 months after surgery, the incidence of postoperative complications were analyzed. Results There was no significant difference in operative incision length and operation time between the DAA group and the PLA group(P>0.05). The intraoperative blood loss, postoperative drainage, total blood loss, the activity time and the average hospital stay of DAA group were less than those of PLA group(P 0.05); the VAS scores of 1, 3, 5 and 7 days in the DAA group were smaller than those in the PLA group(P<0.05). Two patients had posterior dislocation of the PLA group. Conclusion The DAA of THA has the advantages of less pain, less bleeding, strong anti dislocation ability, rapid recovery; at the same time, the DAA of THA doesn′t need special operation bed, simple disinfection, it has the same position with PLA, which will not increase the difficulty of surgery because of changes in position, shorten the learning curve. Key words: Hip arthroplasty; Lateral decubitus position; Direct anterior approach; Posterolateral approach; Developmental dysplasia of hip

The Effect of Lateral Decubitus Position on Nocturnal Intraocular Pressure over a Habitual 24-Hour Period in Healthy Adults

PurposeTo investigate the effect of lateral decubitus position (LDP) on nocturnal intraocular pressure (IOP) and the effect of LDP on 24-hour habitual IOP pattern in healthy subjects.MethodsIntraocular pressure was measured every 2-hours using an Accupen Applanation Tonometer (Accutome, USA). During the diurnal period (7:30 am, 9:30 am, 11:30 am, 1:30 pm, 3:30 pm, 5:30 pm, 7:30 pm, and 9:30 pm), IOP was measured in the sitting position under bright light (500–1000 lux) after the subjects had been seated for 5 min. The nocturnal IOP was measured in the supine position, right LDP, and left LDP, with randomized sequences, under dim light (<10 lux) at 11:30 pm, 1:30 am, 3:30 am, and 5:30 am. The subjects were awakened and maintained each position for 5 min before the measurement. The 24-hour habitual IOP patterns were obtained according to the nocturnal position (supine, right LDP and left LDP) for either eye. P<0.05 was considered to be significant.ResultsNineteen healthy subjects were included with a mean age of 51.3±5.8 years. During the nocturnal period, a significant IOP difference was found between the dependent eye (the eye on the lower side) of LDP and the supine position, but not for all the nocturnal time points. Over a 24-hour period, the effect of LDP on habitual IOP pattern was not statistically significant, although the mean nocturnal IOP and the diurnal-nocturnal IOP change for the right and the left eye in the LDP pattern was slightly higher than that in the sitting-supine pattern.ConclusionSignificant nocturnal IOP differences existed between the dependent eye and the supine, but did not occur consistently for all time points. Over a 24-hour period, the effect of LDP on habitual IOP pattern was not statistically significant in healthy subjects.

Effect of Lateral Decubitus Position on Intraocular Pressure in Glaucoma Patients with Asymmetric Visual Field Loss

To investigate the effect of the lateral decubitus position (LDP) on intraocular pressure (IOP) in glaucoma patients with asymmetric visual field loss. Prospective, cross-sectional study. Ninety-eight eyes of 49 consecutive bilateral glaucoma patients with asymmetric visual field loss, divided into better eye and worse eye groups for calculation of mean deviation. Intraocular pressure was measured using a Goldmann applanation tonometer and rebound tonometer (Icare PRO; Icare Finland Oy, Helsinki, Finland) in each of the following positions: sitting, supine, right LDP, and left LDP. Visual field was examined using the Humphrey Field Analyzer (HFA II; Carl Zeiss Meditec, Dublin, CA). A questionnaire on the preferred lying position during sleep was administered to each of the patients. The IOPs measured by rebound tonometer for the better and worse eyes in each position were compared using paired t tests. Agreement between the Goldmann applanation tonometry and rebound tonometry results was assessed by a Bland-Altman plot. The IOPs of the better and worse eyes in the sitting position showed no significant difference (P<0.476). The IOP of the worse eye was significantly higher than that of the better eye in the supine position (16.8 ± 3.0 mmHg vs. 15.1 ± 1.8 mmHg; P<0.001). The IOPs of the worse and better eyes in their dependent LDP were 19.1 ± 3.0 mmHg and 17.6 ± 2.3 mmHg, respectively (change in IOP, 1.6 ± 2.4 mmHg; P<0.001). Of the enrolled patients, 75.5% preferred the LDP, and 75.7% of these LDP-preferring patients preferred the worse eye dependent-LDP. The Bland-Altman plot comparing the Goldmann applanation tonometry and rebound tonometry readings showed reasonable agreement between the 2 methods (r(2)<0.001; P = 0.972). This study showed that IOP-elevation asymmetry in LDP is associated with asymmetric visual field loss in glaucoma patients. The LDP, habitually preferred by glaucoma patients, also may be associated with asymmetric visual field damage.

The Effect of Lateral Decubitus Position on Intraocular Pressure in Patients with Untreated Open-Angle Glaucoma

To investigate the effect of change of body posture from the supine to the lateral decubitus position on intraocular pressure (IOP) in patients with open-angle glaucoma. Prospective, observational case series. Setting. Institutional. Participants. Forty-four eyes of 22 patients with newly diagnosed bilateral open-angle glaucoma. Observation procedures. IOP was measured using the Tono-Pen XL (Reichert Inc) in both eyes 10minutes after assuming each position: sitting, supine, right lateral decubitus, supine, left lateral decubitus, and supine. By comparing the mean deviation (MD) of Humphrey visual field between both eyes of a patient, eyes were classified into either worse-MD eye or better-MD eye. Main outcome measures. Magnitude of IOP alterations by postural changes and intereye difference of IOP with each posture. The mean ± SD IOP of the dependent eyes (eye on the lower side in the lateral decubitus position) increased after changing from the supine to the right lateral decubitus position (19.1 ± 2.6mm Hg vs 21.0 ± 2.7mm Hg; P= .019) or the left lateral decubitus position (18.6 ± 2.9mm Hg vs 20.6 ± 3.1mm Hg; P= .002). The mean IOP of the dependent eyes was significantly higher than that of the nondependent eyes in the lateral decubitus positions (right lateral decubitus,+1.2mm Hg; left lateral decubitus,+1.6mm Hg; both, P < .05). Compared with the better-MD eyes, the worse-MD eyes showed a tendency for greater IOP rise with positional change from the supine to lateral decubitus position (2.3 ± 2.2mm Hg vs 1.5 ± 2.1mm Hg; P= .065). The postural change from the supine tolateral decubitus position may increase the IOP ofthe dependent eyes in patients with open-angle glaucoma.

The effect of lateral decubitus position on intraocular pressure in healthy young subjects

To investigate the effect of change of body posture from supine to lateral decubitus position (LDP) on intraocular pressure (IOP) in healthy young subjects. We evaluated 38 eyes of 19 healthy young Korean subjects. IOP was measured using Tonopen XL in both eyes in the sitting and supine position, 5 and 30 min after right LDP and 5 min after returning to the supine position. A week later, IOP was measured in the same sequence except that the subjects assumed the left LDP. The eye on the lower side in the LDP was termed as a dependent eye. The mean IOP of the dependent eyes increased significantly at 5 min after changing from supine to right (16.26 ± 2.73 mmHg versus 18.54 ± 2.95 mmHg, p < 0.01) or left LDP (15.53 ± 2.41 mmHg versus 17.53 ± 3.37 mmHg, p < 0.01); this IOP increase in the dependent eyes persisted at 30 min after changing to right (18.47 ± 2.97 mmHg, p < 0.01) or left LDP (17.79 ± 2.20 mmHg, p < 0.01). Upon returning to the supine position, IOP of the dependent eyes decreased significantly (16.83 ± 2.67 mmHg, p < 0.01 for right LDP and 16.47 ± 2.32 mmHg, p < 0.01 for left). However, this effect of the positional change was not found in the non-dependent eyes (all, p > 0.05). Mean IOP in the dependent eye was significantly higher than that in the non-dependent eye at 30 min after changing to the right (+0.89 ± 1.52 mmHg) or left LDP (+1.84 ± 2.03 mmHg). The postural change from supine to LDP significantly increased IOP of the dependent eyes.

Effect of lateral decubitus position on circulation and heart rate variability in healthy adults

There has been little research focus on the autonomic nervous system modulation in the lateral decubitus position. We compared the impact of the right and left lateral decubitus positions and the supine position on heart rate variability (HRV), including circulatory regulation. In 19 nonsmoking, healthy volunteers aged 24.8±4.2 years, we measured blood pressure (BP) in both upper arms and ECG. In addition, we assessed the condition of the inferior vena cava (IVC) by echocardiography in each posture. Subjects maintained each lateral decubitus position at an angle of about 45 degrees for 10 min at random after being in the supine position. Postural change was performed manually by two trained researchers. The systolic and diastolic BPs of the upper arm declined in both lateral positions. No significant differences were observed in high‐frequency or low frequency HRV or their ratio. However, in left lateral decubitus the HR was significantly lower than in the supine position throughout the experiment. In this position, the IVC diameter and area declined, although blood in the IVC flowed rapidly. The HRV findings suggest that the two recumbent positions have no influence on the autonomic nervous system. However, it is possible that the reduction in HR in left lateral decubitus position is followed by changes in the shape of the IVC.

The effect of lateral decubitus position on intraocular pressure in anesthetized patients undergoing lung surgery

The effect of lateral decubitus position on intraocular pressure in anesthetized patients undergoing lung surgery

The Depth of Double Lumen Endobronchial Tube and the Effect of Lateral Decubitus Position to the Depth in Korean Adult Patients

Background : During one-lung anesthesia in thoracic surgery, accurate placement of double lumen endobronchial tube(DLT) is essential. We have only a few data regarding adequate depth of DLT, especially after position change. We measured the depth of DLT and the change of depth after position change in 50 adult patients. Methods : After endotracheal intubation with left-sided Robertshaw type polyvinyl chloride(PVC) endobronchial tube, fiberoptic bronchoscope was inserted through tracheal lumen and we positioned the proximal end of the bronchial cuff just below the carinal bifurcation. The depth of the DLT from the upper incisor was recorded, and was rechecked after position change to lateral position. Results : The depth of the DLT was 29.4 ±1.3 cm(male: 30.2± 0.9, female: 28.2± 0.8) and this was related with height. But in female group depth of DLT was not related with height. Within the same height group, the depth of DLT differ up to 3.5 cm. The change of depth more than 0.5 cm after position change ocurred in 21 out of 50 patients. Conclusion: The adequate depth of DLT in Korean patients, in total patients and in male group seems to related with their height, but in female group the depth of DLT was not related with their height. Within same height group, the depth of DLT may differ greatly. So, the depth of DLT must be adjusted individually. After position change, the head and neck should be kept in neutral position and the adequacy of the depth of DLT must be rechecked. (Korean J Anesthesiol 1997; 32: 390∼396)

Postural effect on the distribution of the pulmonary arterial blood flow.

The postural effect of lateral decubitus position on the distribution of pulmonary arterial blood flow was assessed in 9 normal subjects and 31 patients with pulmonary tuberculosis by radioisotope perfusion scanning of the lungs. The perfusion of the dependent lung was larger than that of the supine lung with out exception. In both normal and tuberculous subjects, the average overall ratio of the pulmonary arterial blood flow in the dependent lung was 1.1 to 1.2 times that of the supine lung in any of the right and left lateral decubitus positions, and this was assumed to be due to gravitational effect. It was clarified that the increase in oxygen uptake in the dependent lung so far reported by many investigators was due to increased distribution of the pulmonary arterial blood flow which was related to gravitational effect.