Effect of Head Rotation on Cerebral Blood Velocity in the Prone Position
Background. The prone position is applied to facilitate surgery of the back and to improve oxygenation in the respirator-treated patient. In particular, with positive pressure ventilation the prone position reduces venous return to the heart and in turn cardiac output (CO) with consequences for cere...
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| Format: | Article |
| Language: | English |
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Wiley
2012-01-01
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| Series: | Anesthesiology Research and Practice |
| Online Access: | http://dx.doi.org/10.1155/2012/647258 |
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| author | Jakob Højlund Marie Sandmand Morten Sonne Teit Mantoni Henrik L. Jørgensen Bo Belhage Johannes J. van Lieshout Frank C. Pott |
| author_facet | Jakob Højlund Marie Sandmand Morten Sonne Teit Mantoni Henrik L. Jørgensen Bo Belhage Johannes J. van Lieshout Frank C. Pott |
| author_sort | Jakob Højlund |
| collection | DOAJ |
| description | Background. The prone position is applied to facilitate surgery of the back and to improve oxygenation in the respirator-treated patient. In particular, with positive pressure ventilation the prone position reduces venous return to the heart and in turn cardiac output (CO) with consequences for cerebral blood flow. We tested in healthy subjects the hypothesis that rotating the head in the prone position reduces cerebral blood flow. Methods. Mean arterial blood pressure (MAP), stroke volume (SV), and CO were determined, together with the middle cerebral artery mean blood velocity (MCA Vmean) and jugular vein diameters bilaterally in 22 healthy subjects in the prone position with the head centered, respectively, rotated sideways, with and without positive pressure breathing (10 cmH2O). Results. The prone position reduced SV (by 5.4±1.5%; P<0.05) and CO (by 2.3±1.9
%), and slightly increased MAP (from 78±3
to 80±2 mmHg) as well as bilateral jugular vein diameters, leaving MCA Vmean unchanged. Positive pressure breathing in the prone position increased MAP (by 3.6±0.8 mmHg) but further reduced SV and CO (by 9.3±1.3
% and 7.2±2.4
% below baseline) while MCA Vmean was maintained. The head-rotated prone position with positive pressure breathing augmented MAP further (87±2 mmHg) but not CO, narrowed both jugular vein diameters, and reduced MCA Vmean (by 8.6±3.2
%). Conclusion. During positive pressure breathing the prone position with sideways rotated head reduces MCA Vmean ~10% in spite of an elevated MAP. Prone positioning with rotated head affects both CBF and cerebrovenous drainage indicating that optimal brain perfusion requires head centering. |
| format | Article |
| id | doaj-art-8d577cdec93641619450ae6685bec831 |
| institution | Kabale University |
| issn | 1687-6962 1687-6970 |
| language | English |
| publishDate | 2012-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Anesthesiology Research and Practice |
| spelling | doaj-art-8d577cdec93641619450ae6685bec8312025-08-20T03:37:54ZengWileyAnesthesiology Research and Practice1687-69621687-69702012-01-01201210.1155/2012/647258647258Effect of Head Rotation on Cerebral Blood Velocity in the Prone PositionJakob Højlund0Marie Sandmand1Morten Sonne2Teit Mantoni3Henrik L. Jørgensen4Bo Belhage5Johannes J. van Lieshout6Frank C. Pott7Department of Anaesthesia, Sygehus Nord, 4300 Holbæk, DenmarkDepartment of Diagnostic Radiology, Bispebjerg University Hospital, 2400 Copenhagen, DenmarkDepartment of Anaesthesia, Bispebjerg Hospital Research Unit for Anaesthesia and Intensive Care (B.R.A.IN), Bispebjerg University Hospital, Bispebjerg Bakke 23, 2400 Copenhagen NV, DenmarkDepartment of Anaesthesia, Bispebjerg Hospital Research Unit for Anaesthesia and Intensive Care (B.R.A.IN), Bispebjerg University Hospital, Bispebjerg Bakke 23, 2400 Copenhagen NV, DenmarkDepartment of Clinical Biochemistry, Bispebjerg University Hospital, 2400 Copenhagen, DenmarkDepartment of Anaesthesia, Bispebjerg Hospital Research Unit for Anaesthesia and Intensive Care (B.R.A.IN), Bispebjerg University Hospital, Bispebjerg Bakke 23, 2400 Copenhagen NV, DenmarkAcute Admissions Unit, Department of Internal Medicine, Laboratory for Clinical Cardiovascular Physiology, AMC Center for Heart Failure, University of Amsterdam, 1105 AZ Amsterdam, The NetherlandsDepartment of Anaesthesia, Bispebjerg Hospital Research Unit for Anaesthesia and Intensive Care (B.R.A.IN), Bispebjerg University Hospital, Bispebjerg Bakke 23, 2400 Copenhagen NV, DenmarkBackground. The prone position is applied to facilitate surgery of the back and to improve oxygenation in the respirator-treated patient. In particular, with positive pressure ventilation the prone position reduces venous return to the heart and in turn cardiac output (CO) with consequences for cerebral blood flow. We tested in healthy subjects the hypothesis that rotating the head in the prone position reduces cerebral blood flow. Methods. Mean arterial blood pressure (MAP), stroke volume (SV), and CO were determined, together with the middle cerebral artery mean blood velocity (MCA Vmean) and jugular vein diameters bilaterally in 22 healthy subjects in the prone position with the head centered, respectively, rotated sideways, with and without positive pressure breathing (10 cmH2O). Results. The prone position reduced SV (by 5.4±1.5%; P<0.05) and CO (by 2.3±1.9 %), and slightly increased MAP (from 78±3 to 80±2 mmHg) as well as bilateral jugular vein diameters, leaving MCA Vmean unchanged. Positive pressure breathing in the prone position increased MAP (by 3.6±0.8 mmHg) but further reduced SV and CO (by 9.3±1.3 % and 7.2±2.4 % below baseline) while MCA Vmean was maintained. The head-rotated prone position with positive pressure breathing augmented MAP further (87±2 mmHg) but not CO, narrowed both jugular vein diameters, and reduced MCA Vmean (by 8.6±3.2 %). Conclusion. During positive pressure breathing the prone position with sideways rotated head reduces MCA Vmean ~10% in spite of an elevated MAP. Prone positioning with rotated head affects both CBF and cerebrovenous drainage indicating that optimal brain perfusion requires head centering.http://dx.doi.org/10.1155/2012/647258 |
| spellingShingle | Jakob Højlund Marie Sandmand Morten Sonne Teit Mantoni Henrik L. Jørgensen Bo Belhage Johannes J. van Lieshout Frank C. Pott Effect of Head Rotation on Cerebral Blood Velocity in the Prone Position Anesthesiology Research and Practice |
| title | Effect of Head Rotation on Cerebral Blood Velocity in the Prone Position |
| title_full | Effect of Head Rotation on Cerebral Blood Velocity in the Prone Position |
| title_fullStr | Effect of Head Rotation on Cerebral Blood Velocity in the Prone Position |
| title_full_unstemmed | Effect of Head Rotation on Cerebral Blood Velocity in the Prone Position |
| title_short | Effect of Head Rotation on Cerebral Blood Velocity in the Prone Position |
| title_sort | effect of head rotation on cerebral blood velocity in the prone position |
| url | http://dx.doi.org/10.1155/2012/647258 |
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