Article
Semi-sitting position in children with intracranial tumours – Does the positioning influence the rate of adverse effects?
Halbsitzende Lagerung bei Kindern mit intrakraniellen Tumoren – Sind die Komplikationen höher als bei anderen Lagerungen?
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Published: | May 30, 2008 |
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Objective: To asses the frequency of adverse intraoperative events in children treated for intracranial neoplasm (air embolism, arterial hypotension, decrease in Sp02), blood loss, and preoperative time delay in semi-sitting position (SSP) compared to other positions (prone-, supine-, lateral- and park bench-position [OP]).
Methods: From 1998–2006 85 Children (age 6 month to 18 years) were treated for intracranial neoplasm. 25 underwent surgery in SSP placed under TEE on the operating table with elevated feed above the level of the transverse sinus. A positive fluid balance and an increased PEEP (+2 mmHg) were mandatory in SSP while standard anaesthesia care was applied in children with OP. The perioperative course of the children was retrospectively evaluated. Events of air embolism, decrease in blood pressure (>20% of the initial systolic pressure), decrease in Sp02 (<95%), total blood loss, need of blood transfusion and preoperative time interval for anaesthesia and positioning were compared in children operated in SSP and OP using SPSS software.
Results: Children with neoplasms of the posterior (n=35) frontal and middle fossa (n=50) were operated in semi-sitting position (n=25) or other position (n=60). No air embolism occurred in children positioned in SSP, but one case in supine position. In SSP arterial hypotension occurred in four children (16%) compared to eight children (13%; p=0,24; Chi2-test). None of them suffered from decreased oxygen level. The mean blood loss was 289ml in the semi-sitting group vs. 370ml in the others (p=0,6; t-test). The mean blood transfusion in SSP was 0.8ml/kg body weight compared to 3.8 ml/kg body weight in OP (p=0.11; t-test). Preoperative anaesthesia preparation time and time for positioning did not differ significantly (100.7±32min vs. 121±47min (p=0.1; t-test).
Conclusions: Despite the slightly higher risk of arterial hypotension, the semi-sitting position is not associated with a higher rate of adverse events in children undergoing surgery for posterior fossa lesions. The need of blood transfusion is lower in SSP. There is no time delay due to positioning and anaesthesia in SSP.