Cardiac Output and Other Hemodynamic Changes With Prone Position in Cervical Myelopathy Patients Undergoing Surgery

Cardiac Output and Other Hemodynamic Changes With Prone Position in Cervical Myelopathy Patients Undergoing Surgery

Positioning a patient in prone position under anaesthesia significantly alters cardiovascular physiology. Cervical myelopathy patients are known to have autonomic dysfunction. Such patients when positioned in prone position under anaesthesia carry a higher risk of developing hemodynamic changes and this can compromise spinal cord perfusion.

This prospective observational study was conducted on 30 patients with cervical myelopathy who underwent surgery in prone position at NIMHANS, Bangalore hospital. The non invasive cardiac output monitor (NICOM, Cheetah Medicals) was used to record various hemodynamic parameters. The hemodynamic parameters were recorded at baseline, post induction, post intubation, prior to prone position, post prone position, and every five minutes thereafter upto 20mins.

The hemodynamic parameters that were recorded using the NICOM monitor:

• HR - Heart rate (beats /min)
• NIBP - non invasive blood pressure (mmHg)
• MAP - mean arterial pressure(mmHg)
• CO - cardiac output (l/min)
• CI - cardiac index (l/min/m2)
• SV - Stroke volume (ml/beat)
• SVV -stroke volume variability (%)
• TPR - total peripheral resistance (dynes. sec/cm5)

Inclusion Criteria:

Cervical myelopathy patients undergoing surgery in prone position with:

• ASA Class I , II and III
• Age between 18 to 65 years
• Nurick's grade 2 or more

Exclusion Criteria:

• Atlanto occipital dislocation and cervicomedullary junction pathology
• Tumour pathology
• Diabetic patients
• Patients positioned prone in the awake state (without induction of anaesthesia)