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PubMed1994

Effect of lordosis on the position of the nucleus pulposus in supine subjects. A study using magnetic resonance imaging.

STUDY DESIGN: Healthy young women (N = 20) underwent magnetic resonance imaging while supine with their hips and knees flexed (flexed position) and supine with a lumbar roll under the low back (extended position). The posterior and anterior margins of the nucleus pulposus (NP) relative to posterior and anterior margins of the adjacent vertebral bodies were calculated from mid-sagittal T2-weighted images to determine the position change of the NP as a function of two supine postures. OBJECTIVES: This study describes the effect of two commonly used supine postures on the position of the NP. SUMMARY OF BACKGROUND DATA: Management of patients with low back pain is often based on theorized positional changes of the NP during spinal extension and flexion. Data describing NP positional changes have not been reported for noninvasive measurements. RESULTS: The distance of the posterior margin of the NP to the posterior margins of the adjacent vertebral bodies was greater in the extended compared with the flexed position. There was no difference in the anterior distance. Eight of the 20 subjects had at least one degenerative disc in the lower lumbar spine. The NPs of the degenerative discs did not move the same as normal discs. CONCLUSIONS: The use of a lumbar roll under the low back when supine causes an increase in the distance from the posterior margin of the NP to the posterior portions of the vertebral bodies in normal discs of healthy young females. Degenerative discs deform differently from nondegenerative discs.

Adult↗
PubMed2006

Treatment of the supination deformity in the pediatric brachial plexus patient.

A supination deformity of the forearm can occur after brachial plexus palsy. The initial deformity is correctable; however, a fixed deformity often develops over time. Fixed supination creates difficulties with activities of daily living, impairs tenodesis grasp and gravity release, and limits the ability to perform bimanual activities. In the supple or passively correctable forearm, restoring active supination via tendon transfer frequently leads to better function. The fixed supination deformity, however, is not amenable to tendon transfer. An osteotomy of the radius and/or ulna is necessary to reposition the limb into pronation. A biceps transfer may be performed at the same time to further balance the forearm and prevent recurrence. This article describes our preferred surgical technique for both supple and fixed supination deformities of the forearm.

Adolescent↗
PubMed2006

Randomized comparison of pain perception during radial head subluxation reduction using supination-flexion or forced pronation.

OBJECTIVE: To determine if a difference exists in perceived pain between the forced pronation and supination-flexion methods of radial head subluxation (RHS) reduction. DESIGN AND METHODS: We developed a prospective randomized trial of children aged 6 months to 7 years who presented to the emergency department (ED) at Miami Children's Hospital with an immobile arm and physical findings suggestive of RHS. Children were randomized into 2 groups for RHS reduction: forced pronation and supination-flexion. Parents, physicians, and nurses were given a standard visual analog pain scale for pain assessment before, during, and at 1 minute after successful reduction. RESULTS: Seventy-five children presented to the ED with RHS; 3 children were excluded from the study because of nonadherence to the protocol and another 9 were excluded because of unsuccessful reduction during the first attempt. Of the remaining children, 32 children underwent forced pronation and 31 underwent supination-flexion. Physicians did not find a significant difference in gain scores between their perceptions of the premeasure and postmeasure of pain between those patients receiving supination-flexion and those receiving forced pronation. For nurses (P < 0.031) and parents (P < 0.043), there were statistically significant differences in gain scores. Nurses and parents perceived forced pronation as being less painful. The mean difference for parents was 1.7 cm, which exceeded the value of 1.3 cm identified as clinically significant. CONCLUSIONS: Forced pronation is perceived as less painful than the supination-flexion method by parents of children treated for RHS in our ED.

Arm Injuries↗
PubMed2005

Risk of injury to adjacent organs with lower-pole fluoroscopically guided percutaneous nephrostomy: evaluation with prone, supine, and multiplanar reformatted CT.

PURPOSE: To assess the risk of injury to organs near the kidney during lower-pole fluoroscopically guided percutaneous nephrostomy by evaluation of prone, supine, and multiplanar reformatted computed tomography (CT). MATERIALS AND METHODS: Eighty-three patients who underwent prone and supine CT examinations were identified retrospectively. The expected path of nephrostomy tube placement to the lower-pole calyx was simulated on prone and supine axial images and multiplanar CT reformations. Intervening organs along this path were considered at risk for injury and were recorded for each kidney (N = 166). RESULTS: The risk of organ injury as determined on multiplanar reformatted prone images (n = 5) and supine images (n = 0) was significantly less (P < .05) than determined on axial prone images (n = 25) or supine images (n = 10). The colon was the only organ identified to be at risk for injury during the simulated lower-pole percutaneous nephrostomy placement; spleen and liver were not seen along the nephrostomy path on axial or multiplanar reformatted images. CONCLUSION: Lower-pole fluoroscopically guided percutaneous nephrostomy carries a low risk of visceral injury, and the risk of injury is overestimated by evaluation of axial CT images alone compared with oblique parasagittal reformations.

Adult↗
PubMed2004

Inclusion of epinephrine to hyperbaric tetracaine and the supine position enhance the cephalad spread of spinal anaesthesia compared with hyperbaric teracaine alone in the lithotomy position.

BACKGROUND: Intrathecal epinephrine can produce prolongation of duration of spinal anaesthesia by reducing vascular absorption of the local anaesthetics. The patient's positioning can change the cephalad spread of hyperbaric local anaesthetics by affecting the lordosis of the vertebral canal. These factors combined are expected to affect the cephalad spread of sensory block levels. The purpose of this study was to investigate whether combined use of epinephrine with hyperbaric tetracaine in the supine position can enhance the cephalad spread of sensory block levels compared with hyperbaric tetracaine alone in the lithotomy position. METHODS: ASA physical status I or II 48 urological (lithotomy group) and 48 orthopaedic patients (supine group) scheduled to undergo elective surgical procedures in the lithotomy or supine position under spinal anaesthesia were enrolled. Patients in each group were randomly divided into two subgroups to receive intrathecal 10 mg of hyperbaric tetracaine with or without 0.2 mg of epinephrine (Groups L, LE, S, and SE). The extent of sensory blockade was assessed by loss of cold sensation. After achievement of sensory blockade up to T10, the patients in Groups L and LE were immediately placed in the lithotomy position. Patients in Groups S and SE were maintained in the supine position. RESULTS: The highest sensory blockade in the SE Group was on average statistically significantly higher than in the L Group. The mean time taken to the highest sensory blockade in the SE Group was statistically significantly longer than in Groups L and S. Atropine for bradycardia was used more frequently in the SE Group than in the other groups. CONCLUSIONS: Combined use of epinephrine with hyperbaric tetracaine in the supine position can enhance the cephalad spread of sensory block levels compared with hyperbaric tetracaine alone in the lithotomy position.

Aged↗
PubMed2005

Effects on intracranial pressure of dural puncture in supine and head-elevated positions. A study on the cat.

BACKGROUND: Lumbar dural puncture may reduce intracranial pressure (ICP) due to a hydrostatic pressure gradient created by distal opening of the spinal fluid column towards the atmosphere. The magnitude of the reduction in hydrostatic force on the brain should depend on the vertical distance between the brain and the dural opening, and thus will increase by head elevation. No studies have analyzed ICP after dural puncture in supine and upright positions. METHODS: This study on the cat records ICP, mean arterial pressure, and central venous pressure before and after dural puncture in supine and head-elevated positions. The dural puncture was performed at a level corresponding to the lumbar region. RESULTS: Initially ICP was 10.9 +/- 1.9 mmHg (mean +/- SD), which decreased to 5.1 +/- 2.0 mmHg after 24.5 cm (18 mmHg) of head elevation (n = 7). Intracranial pressure decreased to 5.2 +/-3.5 mmHg following dural puncture in the supine position and to -11.3 +/- 4.2 mmHg after the head elevation (n = 7). Active drainage of CSF fluid in the supine position in a volume similar to that spontaneously drained after head elevation reduced ICP by 2.0 +/- 0.5 mmHg (n = 3). CONCLUSIONS: The results show that a significant ICP reduction may occur following opening of the spinal canal. The reduction can be explained more by hydrostatic forces than by loss of CSF; also explaining why it is more significant when upright than supine. The decrease in ICP increases transvascular pressure, which may induce the disappearance of the normally present subdural venous collapse with an increase in venous blood volume.

Animals↗
PubMed1999

Different effects of an oral anticholinergic drug on gastroesophageal reflux in upright and supine position in normal, ambulant subjects: a pilot study.

OBJECTIVE: There is controversy in the literature on the effects of anticholinergic drugs on gastroesophageal reflux. Our aim was to study more extensively the effects of an oral anticholinergic drug on esophageal motility and gastroesophageal reflux in normal ambulant subjects under different circumstances: upright, supine, fed, and fasted state. METHODS: Fifteen healthy subjects (seven men, eight women), mean age 34 yr (range, 22-61 yr) underwent randomized placebo-controlled 16-h evening and overnight ambulatory esophageal motility/pH study. After a 3-day loading dose of either oral dicyclomine (Dic) 20 mg four times daily or placebo (Pla), an ambulatory esophageal motility/pH study was performed while taking medication or placebo. Each study was analyzed for meal, first and second h postprandial, upright and supine periods, and first 2 h supine after bedtime snack. RESULTS: The mean number of reflux episodes decreased with dicyclomine during the first h postprandial (Dic, 1.9 vs Pla, 2.5; p < 0.05). During the first 2 h supine, mean number of reflux episodes increased with dicyclomine (Dic, 1.4 vs Pla, 0.8; p < 0.09), as did mean percent time pH < 4 (Dic, 2.6 vs Pla, 0.5; p < 0.04), with an increase in clearance time (Dic, 0.9 vs Pla, 0.3; p < 0.05; in min). Mean peristaltic amplitude decreased with dicyclomine during the 2nd h postprandial (Dic, 48.8 vs Pla, 56.3; p < 0.04). CONCLUSIONS: Oral dicyclomine caused a decrease in early postprandial upright reflux episodes, but also significantly increased the percent time pH < 4 during the first two h supine. Therefore, its effects are dependent on body position and fasted or fed state. Our results justify additional studies with oral anticholinergic agents in patients with gastroesophageal reflux disease.

Administration, Oral↗
PubMed2002

Haemodynamic changes during neck pressure and suction in seated and supine positions.

We sought to quantify the contribution of cardiac output (Q) and total vascular conductance (TVC) to carotid baroreflex-mediated changes in mean arterial pressure (MAP) in the upright seated and supine positions. Acute changes in carotid sinus transmural pressure were evoked using brief 5 s pulses of neck pressure and neck suction (NP/NS) via a simplified paired neck chamber that was developed to enable beat-to-beat measurements of stroke volume using pulse-doppler ultrasound. Percentage contributions of Q and TVC were achieved by calculating the predicted change in MAP during carotid baroreflex stimulation if only the individual changes in Q or TVC occurred and all other parameters remained at control values. All NP and NS stimuli from +40 to -80 Torr (+5.33 to -10.67 kPa) induced significant changes in Q and TVC in both the upright seated and supine positions (P < 0.001). Cardiopulmonary baroreceptor loading with the supine position appeared to cause a greater reliance on carotid baroreflex-mediated changes in Q. Nevertheless, in both the seated and supine positions the changes in MAP were primarily mediated by alterations in TVC (percentage contribution of TVC at the time-of-peak MAP, seated 95 +/- 13, supine 76 +/- 17 %). These data indicate that alterations in vasomotor activity are the primary means by which the carotid baroreflex regulates blood pressure during acute changes in carotid sinus transmural pressure.

Adaptation, Physiological↗
PubMed2004

Registration of central paths and colonic polyps between supine and prone scans in computed tomography colonography: pilot study.

Computed tomography colonography (CTC) is a minimally invasive method that allows the evaluation of the colon wall from CT sections of the abdomen/pelvis. The primary goal of CTC is to detect colonic polyps, precursors to colorectal cancer. Because imperfect cleansing and distension can cause portions of the colon wall to be collapsed, covered with water, and/or covered with retained stool, patients are scanned in both prone and supine positions. We believe that both reading efficiency and computer aided detection (CAD) of CTC images can be improved by accurate registration of data from the supine and prone positions. We developed a two-stage approach that first registers the colonic central paths using a heuristic and automated algorithm and then matches polyps or polyp candidates (CAD hits) by a statistical approach. We evaluated the registration algorithm on 24 patient cases. After path registration, the mean misalignment distance between prone and supine identical anatomic landmarks was reduced from 47.08 to 12.66 mm, a 73% improvement. The polyp registration algorithm was specifically evaluated using eight patient cases for which radiologists identified polyps separately for both supine and prone data sets, and then manually registered corresponding pairs. The algorithm correctly matched 78% of these pairs without user input. The algorithm was also applied to the 30 highest-scoring CAD hits in the prone and supine scans and showed a success rate of 50% in automatically registering corresponding polyp pairs. Finally, we computed the average number of CAD hits that need to be manually compared in order to find the correct matches among the top 30 CAD hits. With polyp registration, the average number of comparisons was 1.78 per polyp, as opposed to 4.28 comparisons without polyp registration.

Algorithms↗
PubMed2000

Ventilatory sensitivity to mild asphyxia: prone versus supine sleep position.

AIMS: To compare the effects of prone and supine sleep position on the main physiological responses to mild asphyxia: increase in ventilation and arousal. METHODS: Ventilatory and arousal responses to mild asphyxia (hypercapnia/hypoxia) were measured in 53 healthy infants at newborn and 3 months of age, during quiet sleep (QS) and active sleep (AS), and in supine and prone sleep positions. The asphyxial test mimicked face down rebreathing by slowly altering the inspired air: CO(2), maximum 5% and O(2), minimum 13.5%. The change in ventilation with inspired CO(2) was measured over 5-6 minutes of the test. The slope of a linear curve fit relating inspired CO(2) to the logarithm of ventilation was taken as a quantitative measure of ventilatory asphyxial sensitivity (VAS). Sleep state and arousal were determined by behavioural criteria. RESULTS: At 3 months of age, prone positioning in AS lowered VAS (0.184 prone v 0.269 supine, p = 0.050). At newborn age, sleep position had no effect on VAS. Infants aged 3 months were twice as likely to arouse to the test than newborns (p = 0.013). Placing infants prone as opposed to supine increased the chances of arousal 1.57-fold (p = 0.035). CONCLUSION: Our findings show 3 month old babies sleeping prone compared to supine have poorer ventilatory responses to mild asphyxia, particularly in AS, but the increased prevalence of arousal is a protective factor.

Arousal↗
PubMed2003

Comparison of transient heart rate reduction associated with acupuncture stimulation in supine and sitting subjects.

We investigated the difference in transient heart rate reduction associated with brief acupuncture in 20 healthy subjects at rest in a supine and in a sitting position. After the subjects had been at rest for about 20 minutes, acupuncture needling using the sparrow-pecking method, in which the needle is moved vertically lifting and thrusting, was performed for one minute at the Shousanli point on the right forearm (LI10). The procedure was carried out with the subjects in a supine position and in a sitting position. The position for stimulation of each subject, either supine or sitting, was selected at random, and on different days. The results showed that the average heart rate reduction associated with stimulation in supine subjects was 3.6 +/- 0.19 (mean +/- standard error (SE)) beats per minute (bpm), while that for sitting subjects was about 7.0 +/- 1.07 (mean +/- SE) bpm, indicating that stimulation reduces heart rate to a greater degree in subjects who are sitting (p<0.05, Mann-Whitney test). These results would be consistent with a mechanism involving reduced sympathetic drive to the heart, as sympathetic nerve activity has more influence on the heart rate in the sitting than in the supine position.

Acupuncture Points↗
PubMed1999

Supine exercise restores arterial blood pressure and skin blood flow despite dehydration and hyperthermia.

We determined whether the deleterious effects of dehydration and hyperthermia on cardiovascular function during upright exercise were attenuated by elevating central blood volume with supine exercise. Seven trained men [maximal oxygen consumption (VO(2 max)) 4.7 +/- 0. 4 l/min (mean +/- SE)] cycled for 30 min in the heat (35 degrees C) in the upright and in the supine positions (VO(2) 2.93 +/- 0.27 l/min) while maintaining euhydration by fluid ingestion or while being dehydrated by 5% of body weight after 2 h of upright exercise. When subjects were euhydrated, esophageal temperature (T(es)) was 37. 8-38.0 degrees C in both body postures. Dehydration caused equal hyperthermia during both upright and supine exercise (T(es) = 38. 7-38.8 degrees C). During upright exercise, dehydration lowered stroke volume (SV), cardiac output, mean arterial pressure (MAP), and cutaneous vascular conductance and increased heart rate and plasma catecholamines [30 +/- 6 ml, 3.0 +/- 0.7 l/min, 6 +/- 2 mmHg, 22 +/- 8%, 14 +/- 2 beats/min, and 50-96%, respectively; all P < 0. 05]. In contrast, during supine exercise, dehydration did not cause significant alterations in MAP, cutaneous vascular conductance, or plasma catecholamines. Furthermore, supine versus upright exercise attenuated the increases in heart rate (7 +/- 2 vs. 9 +/- 1%) and the reductions in SV (13 +/- 4 vs. 21 +/- 3%) and cardiac output (8 +/- 3 vs. 14 +/- 3%) (all P < 0.05). These results suggest that the decline in cutaneous vascular conductance and the increase in plasma norepinephrine concentration, independent of hyperthermia, are associated with a reduction in central blood volume and a lower arterial blood pressure.

Adult↗
PubMed2001

Pulmonary perfusion in supine and prone positions: an electron-beam computed tomography study.

Acute respiratory distress syndrome is characterized by alterations in the ventilation-perfusion ratio. Present techniques for studying regional pulmonary perfusion are difficult to apply in the critically ill. Electron-beam computed tomography was used to study the effects of prone positioning on regional pulmonary perfusion in six healthy subjects. Contrast-enhanced sections were obtained sequentially in the supine, prone, and (original) supine positions at full inspiration. Regions of interest were placed along the nondependent to dependent axis and relative perfusion calculated. When corrected for the redistribution of lung parenchyma, a gravitational gradient of pulmonary perfusion existed in both supine and prone positions. The distribution of perfusion between the supine or prone positions did not differ, but data analysis using smaller regions of interest demonstrated marked heterogeneity of perfusion between anatomically adjacent regions of lung. The distribution of lung parenchyma was more uniform in the prone position. Gravity was estimated to be responsible for 22-34% of perfusion heterogeneity in the supine and 27-41% in the prone positions. These data support the hypothesis that factors other than gravity may be at least as important in determining the distribution of pulmonary perfusion in humans. The influence of nongravitational factors may not be detectable if techniques that sample large tissue volumes are employed.

Adult↗
PubMed2001

Supine position decreases the ability of the nose to warm and humidify air.

We tested the hypothesis that decreasing nasal air volume (i.e., increasing nasal turbinate blood volume) improves nasal air conditioning. We performed a randomized, two-way crossover study on the conditioning capacity of the nose in six healthy subjects in the supine and upright position. Cold, dry air (CDA) was delivered to the nose via a nasal mask, and the temperature and humidity of air were measured before it entered and after it exited the nasal cavity. The total water gradient (TWG) across the nose was calculated and represents the nasal conditioning capacity. Nasal volume decreased significantly from baseline without changing the mucosal temperature when subjects were placed in the supine position (P < 0.01). TWG in supine position was significantly lower than that in upright position (P < 0.001). In the supine position, nasal mucosal temperature after CDA exposure was significantly lower than that in upright position (P < 0.01). Our data show that placing subjects in the supine position decreased the ability of the nose to condition CDA compared with the upright position, in contrast to our hypothesis.

Adult↗
PubMedDate not supplied

Effect of a neoprene sleeve on knee joint position sense during sitting open kinetic chain and supine closed kinetic chain tests.

The primary objective of the present study was to compare the effect of a neoprene sleeve on knee joint position sense during a sitting open kinetic chain test and a supine closed kinetic chain test. Young (24 +/- 2 years old), healthy subjects (18 men and 18 women) performed knee joint angle replication tests during open kinetic chain knee extension (sitting) and closed kinetic chain leg press (supine with an axial load of 15% body weight) before and after application of a neoprene sleeve over the dominant knee. The improvement in ability to replicate joint angles after application of the sleeve (sleeve effect) was significantly less during the supine closed kinetic chain test (0.3 degree +/- 1.4 degrees) than during the sitting open kinetic chain test (1.2 degrees +/- 1.1 degrees). The sleeve effect was inversely related to subjects' performance without the sleeve during both the sitting open kinetic chain and supine closed kinetic chain tests, suggesting that some people may derive greater benefit from the sleeve than others. Although the sleeve effects were small, particularly during the supine closed kinetic chain test, 72% of subjects felt that the sleeve improved their overall test performance. Future research is needed to establish the functional relevance of the small sleeve effects observed and to identify the characteristics of people who might derive greatest benefit from sleeve use.

Adult↗
PubMed2001

Enteral feeding in the critically ill: comparison between the supine and prone positions: a prospective crossover study in mechanically ventilated patients.

INTRODUCTION: Prone position is effective in mechanically ventilated patients to improve oxygenation. It is unknown if prone position affects gastric emptying and the ability of continued enteral feeding. AIM: To determine tolerance of enteral feeding by measuring gastric residual volumes in enterally fed patients during supine and prone positions. METHODS: Consecutive mechanically ventilated intensive care patients who were turned to prone position were included. All patients were studied for 6 hours in supine position, immediately followed by 6 hours in prone position, or vice versa. The rate of feeding was unchanged during the study period. Gastric residual volume was measured by suctioning the naso-gastric tube after 3 and 6 hours in the same position. Wilcoxon test and regression analysis were used for analysis. RESULTS: The median volume of administered enteral feeds was 95 ml after 6 hours in supine position and 110 ml after 6 hours in prone position (P = 0.85). In 10 patients, a greater gastric residual volume was found in prone position. In eight others a greater volume was found in supine position. In 18 of 19 patients, gastric residual volumes in both positions were > or = 150 ml in 6 hours or < or = 150 ml in 6 hours. Significantly more sedatives were used in prone position. Regression analysis excluded dopamine dose and the starting position as confounders. CONCLUSION: Our results suggest that enteral feeding can be continued when a patient is turned from supine to prone position or vice versa. The results indicate that patients with a clinically significant gastric residual volume in one position are likely to have a clinically significant gastric residual volume in the other position.

Adult↗
PubMed2006

Lung and 'end organ' injury due to mechanical ventilation in animals: comparison between the prone and supine positions.

INTRODUCTION: Use of the prone position in patients with acute lung injury improves their oxygenation. Most of these patients die from multisystem organ failure and not from hypoxia, however. Moreover, there is some evidence that the organ failure is caused by increased cell apoptosis. In the present study we therefore examined whether the position of the patients affects histological changes and apoptosis in the lung and 'end organs', including the brain, heart, diaphragm, liver, kidneys and small intestine. METHODS: Ten mechanically ventilated sheep with a tidal volume of 15 ml/kg body weight were studied for 90 minutes. Five sheep were placed in the supine position and five sheep were placed in the prone position during the experiment. Lung changes were analyzed histologically using a semiquantitative scoring system and the extent of apoptosis was investigated with the TUNEL method. RESULTS: In the supine position intra-alveolar hemorrhage appeared predominantly in the dorsal areas, while the other histopathologic lesions were homogeneously distributed throughout the lungs. In the prone position, all histological changes were homogeneously distributed. A significantly higher score of lung injury was found in the supine position than in the prone position (4.63 +/- 0.58 and 2.17 +/- 0.19, respectively) (P < 0.0001). The histopathologic changes were accompanied by increased apoptosis (TUNEL method). In the supine position, the apoptotic index in the lung and in most of the 'end organs' was significantly higher compared with the prone position (all P < 0.005). Interestingly, the apoptotic index was higher in dorsal areas compared with ventral areas in both the prone and supine positions (P < 0.003 and P < 0.02, respectively). CONCLUSION: Our results suggest that the prone position appears to reduce the severity and the extent of lung injury, and is associated with decreased apoptosis in the lung and 'end organs'.

Animals↗
PubMed2003

The relationship between the strength of supination of the forearm and rotation of the shoulder.

In children with obstetric brachial plexus palsy (OBPP) who develop an internal rotation deformity of the shoulder, release of subscapularis improves the range of external rotation of the shoulder and the strength of supination of the forearm. We studied the strength of supination in 35 healthy adult volunteers at 45 degrees of both internal and external rotation. The mean and maximum torques were greater in external than internal rotation by 8.7% and 7.5%, respectively. This was highly significant (p < 0.0001). The increased strength of supination in external rotation is probably because the maximum power of biceps, particularly the long head, may be exerted in this position. In children the difference may be even greater due to anatomical differences causing the dramatic increases in the strength of supination after surgery for OBPP. In adults our findings suggest that the supination exercises which are undertaken after injury or surgery to the forearm or wrist should be performed in external rotation.

Adult↗