Luostarinen Teemu, Lindroos Ann-Christine, Niiya Tomohisa, Silvasti-Lundell Marja, Schramko Alexey, Hernesniemi Juha, Randell Tarja, Niemi Tomi
Division of Anesthesiology, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Division of Anesthesiology, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
World Neurosurg. 2017 Jan;97:261-266. doi: 10.1016/j.wneu.2016.10.005. Epub 2016 Oct 12.
Neurosurgery in general anesthesia exposes patients to hemodynamic alterations in both the prone and the sitting position. We aimed to evaluate the hemodynamic profile during stroke volume-directed fluid administration in patients undergoing neurosurgery either in the sitting or the prone position.
In 2 separate prospective trials, 30 patients in prone and 28 patients in sitting position were randomly assigned to receive either Ringer acetate (RAC) or hydroxyethyl starch (HES; 130 kDa/0.4) for optimization of stroke volume. After combining data from these 2 trials, 2-way analysis of variance was performed to compare patients' hemodynamic profile between the 2 positions and to evaluate differences between RAC and HES consumption.
To achieve comparable hemodynamics during surgery, a higher mean cumulative dose of RAC than HES was needed (679 mL ± 390 vs. 455 mL ± 253; P < 0.05). When fluid consumption was adjusted with weight, statistical difference was lost. Fluid administration did not differ between the prone and sitting position. Mean arterial pressure was lower and cardiac index and stroke volume index were higher over time in patients in the sitting position.
The sitting position does not require excess fluid treatment compared with the prone position. HES is slightly more effective than RAC in achieving comparable hemodynamics, but the difference might be explained by patient weight. With goal-directed fluid administration and moderate use of vasoactive drugs, it is possible to achieve stable hemodynamics in both positions.
全身麻醉下的神经外科手术会使患者在俯卧位和坐位时出现血流动力学改变。我们旨在评估在坐位或俯卧位接受神经外科手术的患者中，进行每搏量导向液体输注时的血流动力学特征。
在两项独立的前瞻性试验中，30例俯卧位患者和28例坐位患者被随机分配接受醋酸林格液（RAC）或羟乙基淀粉（HES；130 kDa/0.4）以优化每搏量。合并这两项试验的数据后，进行双向方差分析以比较两个体位患者的血流动力学特征，并评估RAC和HES用量的差异。
为在手术期间实现可比的血流动力学，所需RAC的平均累积剂量高于HES（679 mL±390 vs. 455 mL±253；P<0.05）。当根据体重调整液体用量时，统计学差异消失。俯卧位和坐位之间的液体输注无差异。坐位患者的平均动脉压随时间降低，心脏指数和每搏量指数随时间升高。
与俯卧位相比，坐位不需要额外的液体治疗。在实现可比的血流动力学方面，HES比RAC稍有效，但这种差异可能由患者体重来解释。通过目标导向的液体输注和适度使用血管活性药物，在两个体位都有可能实现稳定的血流动力学。
