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

Study Overview
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Brief Summary
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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)

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

Conditions
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Hemodynamics Instability

Intervention / Treatment
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* Procedure: Prone Positioning


Participation Criteria
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Eligibility Criteria
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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)

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Intervention/Treatment |
| --- |
|Procedure: Prone Positioning|Noninvasive cardiac output monitoring parameters were recorded before and after prone positioning.|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mean arterial pressure | Analysis of change in mean arterial pressure at following time points - before induction of anaesthesia, 2 minutes after anaesthetic induction, 2 minutes after intubation, before turning prone, immediately after turning prone and every 5 minutes thereafter till 20 minutes after positioning. | Before induction of anaesthesia to 20 minutes after prone positioning (end of study) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Heart rate | Analysis of change in heart rate at following time points - before induction of anaesthesia, 2 minutes after anaesthetic induction, 2 minutes after intubation, before turning prone, immediately after turning prone and every 5 minutes thereafter till 20 minutes after positioning. | Before induction of anaesthesia to 20 minutes after prone positioning (end of study) | 
| Cardiac output | Analysis of change in cardiac output at following time points - before induction of anaesthesia, 2 minutes after anaesthetic induction, 2 minutes after intubation, before turning prone, immediately after turning prone and every 5 minutes thereafter till 20 minutes after positioning. | Before induction of anaesthesia to 20 minutes after prone positioning (end of study) | 
| Stroke volume | Analysis of change in stroke volume at following time points - before induction of anaesthesia, 2 minutes after anaesthetic induction, 2 minutes after intubation, before turning prone, immediately after turning prone and every 5 minutes thereafter till 20 minutes after positioning. | Before induction of anaesthesia to 20 minutes after prone positioning (end of study) | 
| Stroke volume variation | Analysis of change in stroke volume variation at following time points - before induction of anaesthesia, 2 minutes after anaesthetic induction, 2 minutes after intubation, before turning prone, immediately after turning prone and every 5 minutes thereafter till 20 minutes after positioning. | Before induction of anaesthesia to 20 minutes after prone positioning (end of study) | 
| Total peripheral resistance | Analysis of change in total peripheral resistance at following time points - before induction of anaesthesia, 2 minutes after anaesthetic induction, 2 minutes after intubation, before turning prone, immediately after turning prone and every 5 minutes thereafter till 20 minutes after positioning. | Before induction of anaesthesia to 20 minutes after prone positioning (end of study) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Prone positioning, Non-invasive Cardiac Output Monitoring