Key result
Turning children prone for scoliosis surgery resulted in a median reduction in cardiac index of 0.5 l.min(-1).m(-2) (95% CI 0.3-0.7; p=0.001), or 18.5%, with no significant change in blood pressure.
Why the study?
Does positioning prone for scoliosis surgery reduce cardiac index and mean arterial pressure in children undergoing scoliosis repair?
Observational (n=30)
Does positioning prone for scoliosis surgery reduce cardiac index and mean arterial pressure in children undergoing scoliosis repair?
Positioning children prone for scoliosis surgery significantly reduces cardiac index by a median of 18.5%, highlighting the need for strategies to predict and manage this hemodynamic change.
Answers are grounded in this paper and cite their sources.
May support hemodynamic stability with prone positioning in adolescents; leaves open generalizability to other ages or procedures.
In this prospective observational study we investigated the changes in cardiac index and mean arterial pressure in children when positioned prone for scoliosis correction surgery. Thirty children (ASA 1-2, aged 13-18 years) undergoing primary, idiopathic scoliosis repair were recruited. The cardiac index and mean arterial blood pressure (median (IQR [range])) were 2.7 (2.3-3.1 [1.4-3.7]) l.min(-1).m(-2) and 73 (66-80 [54-91]) mmHg, respectively, at baseline; 2.9 (2.5-3.2 [1.7-4.4]) l.min(-1).m(-2) and 73 (63-81 [51-96]) mmHg following a 5-ml.kg(-1) fluid bolus; and 2.5 (2.2-2.7 [1.4-4.8]) l.min(-1).m(-2) and 69 (62-73 [46-85]) mmHg immediately after turning prone. Turning prone resulted in a median reduction in cardiac index of 0.5 l.min(-1).m(-2) (95% CI 0.3-0.7 l.min(-1).m(-2), p=0.001), or 18.5%, with a large degree of inter-subject variability (+10.3% to -40.9%). The changes in mean arterial blood pressure were not significant. Strategies to predict, prevent and treat decreases in cardiac index need to be developed.
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Brown et al. (2013) conducted an observational in Primary, idiopathic scoliosis (n=30). Turning prone vs. Baseline (supine) was evaluated on Change in cardiac index (Median reduction of 0.5 l.min(-1).m(-2), 95% CI 0.3-0.7, p=0.001). Turning children prone for scoliosis surgery resulted in a median reduction in cardiac index of 0.5 l.min(-1).m(-2) (95% CI 0.3-0.7; p=0.001), or 18.5%, with no significant change in blood pressure.
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