Effect Of Patient Position Research Articles

Effect of patient position on the success rate of placing triple-cuffed double lumen endotracheal tubes: a two-center interventional observational study.

Double-lumen endotracheal tubes (DLT) are essential for one-lung ventilation during thoracic surgery. Bronchoscopy is crucial for correct placement of a DLT to avoid complications such as hypoxemia. This study evaluated the effectiveness of the triple-cuffed DLT (tcDLT) in the supine and lateral positions for correct placement without bronchoscopic guidance. This prospective observational study included 167 patients scheduled for elective thoracic surgery requiring one-lung ventilation. The incidence of successful placement of left-sided tcDLTs was compared between the supine and lateral decubitus positions under bronchoscopic surveillance. Successful tcDLT placement was defined as the placement of the proximal end of the bronchial cuff within 5 mm of the carina. Among 153 patients who completed the study, the successful tcDLT placement rate in the lateral position (70.6%) was significantly higher than that in the supine position (50.3%). The rate of difference was 20.3% (95% confidence interval [CI], 10.6-29.9%). The extended successful placement rate, including slightly deeper placements, showed no significant differences between the positions (88.9%; 95% CI, 83.9‒93.9% in supine, 86.3%; 95% CI, 80.8‒91.7% in lateral). tcDLT facilitates correct tube placement in both the supine and lateral positions, with a higher lateral success rate. This finding supports the idea that tcDLTs offer a reliable alternative for lung separation when bronchoscopy is not feasible.

Effect of Patient Position during Spinal Anesthesia on the Incidence of Post-Dural Puncture Headache after Cesarean Section

Objective: To compare the incidence of post-dural puncture headache (PDPH) following spinal anesthesia in parturients undergoing elective cesarean section between the sitting and left lateral decubitus positions. Methodology: This quasi-experimental study was conducted at Holy Family Hospital, Rawalpindi, Pakistan, from May 2022 to October 2022. A total of 120 parturients undergoing elective cesarean section under spinal anesthesia were randomly assigned to either the sitting or left lateral decubitus position group. The primary outcome was the occurrence of PDPH within 5 days postoperatively. Secondary outcomes included adverse effects such as hypotension, nausea/vomiting, and bradycardia. Data were analyzed using SPSS version 25.0. Categorical variables were compared using the chi-square test or Fisher's exact test, as appropriate, with a significance level set at p < 0.05. Results: The incidence of PDPH post-procedure was significantly higher in the sitting group compared to the left lateral decubitus group (33.3% vs. 6.7%). In the sitting position group, 63.3% of women experienced hypotension, 26.7% had bradycardia, and 30.0% reported nausea/vomiting, whereas in the left lateral decubitus group, these figures were 58.3%, 21.7%, and 23.3%, respectively. Conclusion: This study concludes that the left lateral decubitus position during spinal anesthesia for cesarean section is associated with a lower incidence of PDPH compared to the sitting position.

The Effect of Patient Positioning on Ureteral Efflux during Intraoperative Cystoscopy: A Randomized Controlled Trial

<h3>Study Objective</h3> To identify the relationship between patient position during surgery and time to confirmation of ureteral patency on cystoscopy. <h3>Design</h3> Randomized controlled trial. <h3>Setting</h3> Academic tertiary care medical center. <h3>Patients or Participants</h3> A total of 91 adult women undergoing laparoscopic (either conventional or robotic) hysterectomy between February 2021 and February 2022 were randomized to control (n=46) or intervention (n=45). Exclusion criteria included known kidney disease or anomaly, current ureteral stent, pregnancy, malignancy, and recognized intraoperative urinary tract injury. <h3>Interventions</h3> Subjects in the control group were placed in a 0-degree supine position during cystoscopy. Subjects in the intervention group were placed in a 10–20-degree angle in reverse Trendelenburg (RT) during cystoscopy. <h3>Measurements and Main Results</h3> The primary outcome, the time to confirmation of bilateral ureteral patency, was measured at the time the second ureteral jet was viewed during intraoperative cystoscopy. There was no significant difference in mean time to confirmation (66.5 seconds in supine vs 67 seconds in RT, p=0.2), nor in total cystoscopy time (111 seconds in supine vs 104.5 seconds in RT, p=0.39). There were no significant differences in need for alternative modalities to aid in ureteral efflux visualization, delayed diagnosis of ureteric injury, and operative time. RT position seemed to have reduced the time to confirmation for the small group of patients with high confirmation time (>120 seconds). <h3>Conclusion</h3> Reverse Trendelenburg position does not change time to confirmation of bilateral ureteral patency compared to supine position. However, there may be benefit in position change if time to confirmation is >120 seconds.

The Effect of Patient Positioning on Ureteral Efflux During Intraoperative Cystoscopy: A Randomized Controlled Trial

To identify the relationship between patient position during surgery and time to confirmation of ureteral patency on cystoscopy. Randomized controlled trial. Academic tertiary care medical center. A total of 91 adult women undergoing laparoscopic (either conventional or robotic) hysterectomy between February 2021 and February 2022 were randomized to intervention (n=45) or control (n=46). Exclusion criteria included known kidney disease or urinary tract anomaly, current ureteral stent, pregnancy, malignancy, and recognized intraoperative urinary tract injury. Subjects in the control group were placed in a 0° supine position during cystoscopy. Subjects in the intervention group were placed in a 20° angle in reverse Trendelenburg (RT) during cystoscopy. The primary outcome, time to confirmation of bilateral ureteral patency, was measured at the time the second ureteral jet was viewed during intraoperative cystoscopy. There was no significant difference in mean time to confirmation (66.5 seconds in supine vs 67 seconds in RT, p=.2), nor in total cystoscopy time (111 seconds in supine vs 104.5 seconds in RT, p=.39). There were no significant differences in need for alternative modalities to aid in ureteral efflux visualization, delayed diagnosis of ureteric injury, and operative time. RT position seemed to have reduced the time to confirmation for the small group of patients with longer confirmation time (>120 seconds). Reverse Trendelenburg position does not change time to confirmation of bilateral ureteral patency compared to supine position. However, there may be a benefit in position change if time to confirmation is >120 seconds. 'Ureteral Jets and Patient Positioning Study', NCT04732403, Feb 1, 2021, clinicaltrials.gov/ct2/show/NCT04732403, https://data.mendeley.com/datasets/pssg5tf4ws.

The Effect of Patient Positioning on Intraoperative Neuromonitoring During Thyroid and Parathyroid Surgery.

Intraoperative neuromonitoring (IONM) has been accepted as a routine adjunct among surgeons who perform thyroid and parathyroid surgeries. Thyroid and parathyroid surgeries use various patient positioning strategies that have poorly understood effects on IONM. The aim of this study was to compare IONM signals between the transaxillary and transcervical approaches. In this retrospective cohort study, we evaluated 463 adult patients who underwent a total of 502 procedures. The procedures performed included total thyroidectomy, right or left hemithyroidectomy, and parathyroidectomy. Vagus nerve and recurrent laryngeal nerve (RLN) latency and amplitude measurements were analyzed intra-operatively. The distances between the vagus nerve and the trachea were measured via ultrasound during transaxillary procedures. Compared to the transcervical approach, the right vagus nerve latency was significantly decreased in the transaxillary approach. Transaxillary surgery was not associated with increased latency or decreased amplitude on IONM. The distance between the vagus nerve and trachea was significantly decreased post-positioning during transaxillary approaches. Despite differences in patient positioning, a transaxillary approach was not associated with increased stress on the vagus nerve or RLN, according to IONM data. The decreased right vagus nerve latency associated with a transaxillary approach highlights the importance of considering patient positioning and laterality while interpreting IONM data.

The Effect of Patient Position on Psoas Morphology and in Lumbar Lordosis

Among the interbody fusions, lateral lumbar interbody fusion allows access to the lumbar spine through the major psoas muscle, which offers several advantages to the spine surgeon. However, some of its drawbacks cause surgeons to avoid using it as a daily practice. Therefore, to address some of these challenges, we propose the prone transpsoas technique, differing mainly from the traditional technique on patient position-moving from lateral to prone decubitus, theoretically enhancing the lordosis and impacting the psoas morphology. Twenty-four consecutive patients were invited to have magnetic resonance imaging examinations in 3 different positions (prone, dorsal, lateral). Two observers measured the following parameters: vertebral body size, psoas diameter, psoas anterior border distance, plexus distance, total lumbar lordosis, distal lumbar lordosis, and proximal lumbar lordosis. Values of P < 0.05 were deemed significant. The prone position yielded a significant increase in the lumbar lordosis, both in L1-S1 (57° vs. 46.5°) and proximal lordosis (40.4° vs. 36.9°) comparedwith the lateral position. Regarding the morphologic aspects, patients in the prone position presented lesser psoas muscles forward shift, but no difference was noted in the plexus position neither for L3-L4 nor L4-L5. The prone position resulted in a significantly increased lumbar lordosis, both distal and proximal, which may enable the spine surgeon to achieve significant sagittal restoration just by positioning. The prone position also produced a posterior retraction of the psoas muscle. However, it did not significantly affect the position of the plexus concerning the vertebral body.

The effect of patient positioning (prone or supine) on the dose received by small bowel in pelvic radiotherapy in rectal cancer patients

PurposeThe small bowel is a main dose-limiting organ in pelvic radiotherapy in the patients with rectal cancer. Conventionally, pelvic radiotherapy of patients with rectal cancer is performed in the prone position. Material and MethodsThirty-nine patients underwent CT planning scan in the treatment position (20 patients in prone position group and 19 patients in supine position group). After radiation treatment planning optimization, the volumes of the irradiated small intestines were investigated. ResultsThe volume of irradiated small bowel was higher in the supine position (mean difference; 36,274 cm3). However, it was not statistically significant (P value=0.187) ConclusionSupine position could be accepted for the patients undergoing preoperative rectal cancer chemo-radiation.

Perioperative anaesthetic considerations for rotator cuff repair surgeries: A current concept review

Surgeries for Rotator Cuff (RC) pathologies are required for either trauma or degenerative related aetiologies. Various surgical techniques from open to arthroscopic repair, are being undertaken by orthopaedic surgeons. Peri-operative anaesthetic management of the patients undergoing rotator cuff repair requires understanding the surgical procedure and patient status for optimal anaesthetic planning. Such management mandates a thorough pre-operative evaluation, including clinical history, examination, and relevant investigations. Patients with acute trauma associated Rotator Cuff (RC) tears should be assessed for visceral injuries using appropriate injury evaluation systems before such repairs. On the other hand, patients with degenerative tears tend to be older with associated comorbidities. Hence pre-operative optimisation is necessary according to risk stratification. Anaesthetic techniques for Rotator Cuff (RC) surgery include general anaesthesia or regional anaesthesia. These are individualised according to patient assessment and surgical procedure planned. Knowledge of relevant surgical anatomy is essential for intra-operative, and post-operative neural blockade techniques since optimal peri-operative analgesia improve overall patient recovery. The occurrence of a peri-operative complication should be recognised as timely management improves the patient-related surgical outcomes. We describe the relevance of surgical anatomy, the effect of patient positioning, irrigating fluids, various anaesthetic techniques and an overview of regional and medical interventions to manage pain in patients undergoing for Rotator Cuff (RC) surgery.

THE EFFECTS OF PATIENT POSITION ON EARLY COMPLICATIONS OF SPINAL ANESTHESIA INDUCTION IN ARTHROSCOPIC KNEE SURGERY.

SUMMARYSpinal anesthesia is widely used in different patient positions to create efficient and rapid anesthesia induction in surgical interventions. Early and late complications of spinal anesthesia may vary according to the type of needle, drug dose and concentration, patient weight and height, puncture technique, and position of the patient. This study aimed to prospectively compare early complications of spinal anesthesia between patients in sitting and lateral decubitus positions with motor block onset time and sensory block time to T10 level. Spinal anesthesia was performed in 100 ASA I-II patients aged 18-65 years (group S=48; and group L=52) undergoing arthroscopic knee surgery. Hemodynamic data, early complications, sensory and motor block onset times were recorded. Systolic, diastolic and mean arterial pressures were significantly lower in lateral decubitus position as compared to sitting position after spinal anesthesia induction. Arterial blood pressure values decreased significantly in lateral decubitus position as compared with sitting position. Motor block onset time and sensory block onset time were shorter in lateral decubitus position than in sitting position. Accordingly, sitting position could be suggested during induction of spinal anesthesia because it was associated with less pronounced decrease in blood pressures.

Effect of patient position during virtual-assisted lung mapping.

Virtual-assisted lung mapping (VAL-MAP) is a preoperative multi-spot bronchoscopic dye-marking technique. Marking failure reportedly occurs in approximately 10% of marks. The aim of the present study was to investigate whether the patient position during dye injection in VAL-MAP affected the quality of markings. This study was a retrospective review of patients with barely palpable pulmonary nodules who underwent VAL-MAP at a single institution between December 2016 and September 2017. Easily visible markings without bulla formation were defined as "appropriate", while other markings were defined as "inappropriate". Patients were divided in accordance with the position during dye injection into the supine position group (n=6) and the lateral position group (n=8). The two groups were compared regarding the appropriate markings rate. The Fisher exact test and logistic regression model were used for statistical analyses. Fourteen patients with 17 nodules underwent VAL-MAP with a total of 48 markings (3.4±0.9 markings per patient). Of these, 21 markings were performed in supine position, whereas 27 were performed in lateral position. There were no significant differences between the two groups in lesion size, depth, and characteristics. Almost all of the performed procedures were thoracoscopic wedge resections (94%), while one procedure was thoracoscopic left upper division segmentectomy. The appropriate markings rate was significantly greater in the lateral position group than in the supine position group (88% vs. 57%, P=0.02). Among the markings located in dorsal and ventral lung segments, the appropriate markings rate in the lateral position group tended to be greater than that in the supine position group (89% vs. 59%, P=0.06). Multivariate logistic regression analysis revealed that the lateral position was independently associated with appropriate markings (P=0.014). The lateral position may enable the creation of better quality markings in VAL-MAP.

The effect of patient position and pneumoperitoneum on perfusion index and pleth variability index in patients undergoing laparoscopic cholecystectomy

The effect of patient position and pneumoperitoneum on perfusion index and pleth variability index in patients undergoing laparoscopic cholecystectomy

The effect of patient positions on perfusion index

BackgroundThe optimal position for surgery is one in which the patient is provided the best possible surgical intervention and put at minimum risk. Different surgical positions may cause changes in tissue perfusion. This study investigates the relationship between surgical patient positions and perfusion index.MethodsA sample of 61 healthy individuals with no peripheral circulatory disorders, chronic diseases, or anemia was included in this study. Participants held six different positions: supine, prone, 45-degree sitting-supine, 45-degree supine with legs lifted, Trendelenburg (45-degrees head down), and reverse Trendelenburg (45-degrees head up). Perfusion index values were then measured and recorded after individuals held their positions for five minutes.ResultsParticipants’ perfusion index values were affected by different body positions (p < 0.05). Perfusion index was lowest in the sitting position (4.5 ± 2.5) and highest in individuals with Trendelenburg position (7.8 ± 3.8).ConclusionDifferent body positions can cause changes in tissue perfusion. This should be considered in patient follow-up along with the perfusion index.

The accuracy of paediatric weight estimation during simulated emergencies: The effects of patient position, patient cooperation, and human errors.

IntroductionThe effect of patient position and patient cooperation on the accuracy of emergency weight estimation systems has not been evaluated previously. The objective of this study was to evaluate weight estimation accuracy of the Broselow tape, the PAWPER XL tape, the Mercy method, and a custom-designed mobile phone App in a variety of realistic simulated paediatric emergencies.MethodsThis was a prospective study in which 32 emergency medicine volunteers participated in eight simulations of common paediatric emergency conditions, using children models. The participants used each of the four methods to estimate the children’s weight. The accuracy of and time taken for the weight estimations were evaluated for each method. A regression analysis determined the effects of patient position and cooperation on weight estimation accuracy. Evaluation of subgroups of best-performers and worst-performers among the participants provided information on the effects of human user-error on weight estimation accuracy.ResultsThe Broselow tape, Mercy method, App and the PAWPER XL tape achieved percentages of weight estimation within 10% of actual weight in 47.7, 57.3, 68.1, and 73.0% of estimations, respectively. Patient position and cooperation strongly impacted the accuracy of the Broselow tape, had a minimal effect on the Mercy method and the App, and had no effect on the PAWPER XL tape. The best performing participants achieved very high accuracy with all methods except the Broselow tape.DiscussionThe Mercy method, the App, and the PAWPER XL tape achieved exceptionally high accuracy even in uncooperative and sub-optimally positioned children when used by the best-performing participants. Human error, from inexperience and inadequate training, had the most significant impact on accuracy. The Mercy method was the most subject to human error, and the PAWPER XL tape, the least. Adequate training in using weight estimation systems is essential for paediatric patient safety.

Effect of different patient positions on target dose coverage in rectal cancer IMRT

Objective To compare the effect between the supine and prone patient positions upon target dose coverage during intensity-modulated radiotherapy (IMRT) for rectal cancer, aiming to provide clinical reference for the selection of position for rectal cancer patients. Methods Twenty-four patients diagnosed with rectal cancer receiving postoperative adjuvant radiotherapy were selected and divided into the supine (n=12) and prone position groups (n=12). Before and during the IMRT (1-4 weeks), all patients received CT scans, which were defined as: Plan, 1W, 2W, 3W and 4W, respectively. The organs at risk were delineated based on CT scan images. Plan, 1W, 2W, 3W and 4W CT scan images were fused. The CTV and PTV from Plan CT scan were copied to the 1-4W CT scan images, and the therapeutic plans from Plan CT scan were copied as well. The target dose coverage was assessed and the failure rate of target dose coverage was calculated. The couch-position data for each patient during each cycle of IMRT were recorded by using the MOSAIQ network and the overall deviation (S) of couch position was calculated. Results The failure rates of CTV and PTV target dose coverage in the prone position group were higher than those in the supine position group (18.60% VS 0%, 69.76% VS 53.65%). The S value was significantly correlated with the target dose coverage (r=-0.683, P=0.000). The S value in the prone position group was (1.23±0.76) cm, significantly greater than (0.28±0.18) cm in the supine position (P=0.001), and the most significant deviation was noted in the y (head and foot) and z (frontal and dorsal) directions (P=0.003 and 0.003). Compared with the supine group, the V5 and V10 of the small intestine were significantly less (P=0.003 and 0.004) and the chronic toxicity (NTCPC) was considerably reduced (P=0.041) in the prone position group. Conclusions A better target dose coverage can be maintained during IMRT with a supine position during rectal cancer IMRT, whereas the positioning repeatability is worsened with a prone position due to use of the belly board, thereby affecting the target dose coverage. Although the prone position combined with belly board can reduce the tolerated dosage of the small intestine, effective measures should be taken to guarantee the patient positioning repeatability. Key words: Rectal neoplasms/intensity-modulated radiotherapy; Radiotherapy dosage; Belly board

Comparison of ease of intubation in sniffing position and further neck flexion.

Background and Aims:Optimization of patient's head and neck position for the best laryngeal view is the most important step before laryngoscopy and intubation. The objective of this prospective crossover study was to determine the differences, if any, between the gold standard sniffing position (SP) and the further head elevation (HE) (neck flexion) with regard to the incidence of difficult laryngoscopy, intubation difficulty, and variables of the I ntubation Difficulty Scale (IDS) in adult patients undergoing elective surgery under general anesthesia.Material and Methods:In the “SP” the neck must be flexed on the chest by elevating the head with a cushion under the occiput and extending the head at the atlanto-occipital joint. Our study was carried out to evaluate the glottic view in SP compared to further HE by 1.5 inches during direct laryngoscopy in elective surgeries. Patients were randomly assigned to either Group A (“SP” during first laryngoscopy and “HE” during second laryngoscopy) or vice versa in Group B. The effect of patient position on ease of intubation was assessed using a quantitative scale - The intubation difficulty scale (IDS).Results:There were significant differences with regard to glottic visualization (P = 0.00), number of operators (P = 0.001), laryngeal pressure (P = 0.00), and lifting force (P = 0.00) required for intubation and IDS (P = 0.00), thus favoring further HE position.Conclusion:We conclude that the HE position is superior to standard SP with regard to ease of intubation as assessed by IDS.

Effect of patient position on endotracheal cuff pressure in mechanically ventilated critically ill patients

BackgroundEndotracheal tube cuff pressure must be maintained within 20–30mH2O to prevent complications. There is limited literature reporting the impact of nursing care on endotracheal cuff pressure. However, few studies have reported the effect of nursing care on endotracheal cuff pressure. ObjectivesThis study was performed to investigate the effects of body position on endotracheal cuff pressure. MethodsTwenty-five patients receiving mechanical ventilatory therapy were placed in a baseline position (semirecumbent position with the head of the bed elevated at 30° and head in a neutral position) with endotracheal tube cuff was adjusted to 25cmH2O. The patients were moved into 16 different positions: anteflexion of the head; hyperextension of the head; left lateral flexion of the head; right lateral flexion of the head; rotation of the head to the left; rotation of the head to the right; semirecumbent position with 45° elevation of the head of the bed; recumbent position with 10° elevation of the head of the bed; supine position; trendelenburg position 10°; left lateral position at 30°, 45°, and 90°; and right lateral position at 30°, 45°, and 90°. The endotracheal tube cuff pressure was measured and recorded after each position change. ResultsAmong the 400 endotracheal tube cuff pressure measurements (25 patients×16 positions) 10 (2.5%) were lower than 20cmH2O; 201 (50.3%) were between 20–30cmH2O and 189 (47.3%) were higher than 30cmH2O. Mean endotracheal tube cuff pressure increased from 25 to 32.59±4.08cmH2O after changing the patients’ position. Friedman test indicated a statistically significant deviation in the ETCP across the 16 positions (X2: 122.019, p: 0.0001). ConclusionsBody positioning during daily nursing care effected the endotracheal tube cuff pressure, suggesting that endotracheal tube cuff pressure should be measured after changing a patient’s position and adjusted within the recommended range.

The Effect of Patient Position during Mid-Urethral Sling Operations on the Postoperative Outcomes of Sling Success: A Randomized Clinical Study

Aims: To determine and compare the effectiveness, peri- and postoperative outcomes of mid-urethral sling (MUS) operations for urinary incontinence, using 2 different patient positions during surgery. Methods: In this study, 146 patients underwent MUS surgery in a urogynecology clinic. Of them, 72 patients underwent the intraoperative surgical procedure of reverse trendelenburg patient positioning for tape adjustment (group 1) and the remaining 74 patients had the routine surgical procedure of MUS surgery (group 2). The primary outcome was the evaluation of postoperative urine leaks, using the stress test, and secondary outcomes were quality of life, using the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF, Turkish version) and complication rates. Results: There were no significant differences in demographic variables between the 2 groups. The overall cure rates for incontinence in the lithotomy position was 97.22 and 85.13% for groups 1 and 2, respectively, in which group 1 had a statistically significant decrease in urine leak postoperatively (p < 0.05; OR 3.08, 95% CI 2.78-22.14). The postoperative ICQ-SF scores showed no significant difference between the 2 groups (p = 0.19). Conclusion: Applying a 45-degree reverse trendelenburg position for tape adjusting during MUS operation results in a greater objective cure rate compared with the typical dorsolithotomy position; however, there was no difference in the subjective outcome.

Effect of patient position on measurement of patellar height ratio.

Patient position is an important factor which can affect the accuracy of patellar height ratio measurement. Varying degree of knee flexion angles and action of quadriceps muscle while supine or standing positions are the most concerning factors. Forty healthy subjects had radiographs taken of their knees at 0°, 30°, and 60° of flexion in the supine (non-weight-bearing) and standing (weight-bearing) positions. Patellar height was assessed by five different measurement methods including Insall-Salvati (IS), Modified Insall-Salvati (MIS), Caton-Deschamps (CD), Blackburne-Peel (BP), and Knee triangular ratio (KT). The mean and standard deviation (SD) in the supine/standing position of each method were IS 1.0 (0.1)/1.05 (0.1), MIS 1.6 (0.2)/1.8 (0.3), CD 1.0 (0.2)/1.2 (0.2), BP 0.9 (0.2)/1.0(0.2), and KT 1(0.1)/1(0.1). Significant differences were found between supine and standing positions using all of the methods except for KT ratio. Comparisons between the various knee flexion angles were found to be statistically significant by most of the measurement methods, although the differences between the means were less than their SD. Quadriceps action had a significant influence on the mean values obtained by the MIS, CD, and BP methods. In clinical practice, interpretation for patella alta or patella baja of these measurement methods should be normalized according to the patient position. Varying the degree of knee flexion did not produce clinically important effects in any of the five patellar height measurement methods.

Effects of Patient Position on Right-to-Left Shunt Detection by Contrast Transcranial Doppler

Contrast-enhanced transcranial Doppler (c-TCD) was performed on 117 patients to detect a right-to-left shunt (RLS). Each patient was examined during normal breathing and after performing the Valsalva maneuver (VM) in three randomly ordered positions: supine, left lateral decubitus and sitting upright. When breathing normally, RLS-positive rates were 15.4%, 23.1% and 28.2% for supine, left lateral decubitus and upright sitting positions, respectively. After VM, the positive rates were 25.6%, 28.2% and 36.8%, respectively. For each position, the RLS-positive rates were higher after VM than normal breathing and higher for the left lateral decubitus and upright sitting positions compared with the supine position, irrespective of breathing. There were no significant differences between findings for the left lateral decubitus and upright sitting positions. No significant differences in shunt grades were found across all groups. The choice of position for patients undergoing c-TCD can improve its sensitivity for the diagnosis of RLS.

Effect of patient position on pain scales during transrectal ultrasound-guided prostate biopsy

PurposeTransrectal ultrasound (TRUS)-guided prostate biopsy is the most useful technique for the diagnosis of prostate cancer; however, many patients describe the procedure as uncomfortable and painful. We investigated the effect of the patient's position on pain scales during TRUS-guided prostate biopsy.Materials and MethodsBetween July 2012 and June 2013, a total of 128 consecutive patients who underwent TRUS-guided prostate biopsy were included in this study. Seventy patients underwent the procedure in the lithotomy position performed by a urologist and the other patients (n=58) underwent the procedure in the left lateral decubitus (LLD) position performed by a radiologist. Pain was assessed by using visual analogue scale (VAS) scores from 0 to 10. Using a linear regression model, we analyzed the correlation between pain scale score and clinical variables with a focus on patient position.ResultsNo significant differences related to age, body mass index, prostate volume, prostate-specific antigen (PSA), hematuria, pyuria, International Prostate Symptom Score, or the cancer detection rate were observed between the lithotomy and the LLD groups. In the correlation analysis, VAS score showed a significant correlation with diabetes mellitus, PSA level, and lithotomy position (p<0.05). In the multiple linear regression model, VAS score showed a significant correlation with lithotomy position (β=-0.772, p=0.003) and diabetes mellitus (β=-0.803, p=0.033).ConclusionsWe suggest that the lithotomy position may be the proper way to reduce pain during TRUS-guided prostate biopsy.