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PubMed2001

Affective and metabolic responses to hypnosis, autogenic relaxation, and quiet rest in the supine and seated positions.

This study examined the influence of hypnosis, autogenic relaxation, and quiet rest on selected affective states and metabolism. The influence of body position (seated vs. supine) on these same outcome measures was also investigated. Anxiety, tension, and overall mood were assessed before and 30 minutes after each treatment, and oxygen uptake was measured continuously. State anxiety, tension, and a general measure of mood were reduced significantly following each intervention, but oxygen uptake did not change with the exception of small, transient alterations during the physical challenges performed in the hypnosis condition. It is concluded that administration of a routine hypnosis induction to healthy individuals results in a reduction of state anxiety and an improvement of mood commensurate with effects achieved by autogenic training and quiet rest, and these effects occur in both the supine and seated position.

Adolescent↗
PubMed2003

Supine rest reduces platelet activation and aggregation.

Platelet activation and aggregation are central processes in acute coronary syndromes and myocardial infarction, and are stimulated by physical and mental stress. However, it is not known if and to what extent the "ordinary" stress inherent in a person's daily routine contributes to platelet activation and aggregation. We measured platelet activation and aggregation in 12 healthy non-smokers, before and after 45 min supine rest in a calm environment. This simple manouver resulted in a highly significant fall in platelet aggregation (7.9-4.4 ohms, p<0.001) and in plasma epinephrine (35.6-22.5 ng/ml, p = 0.037), norepinephrine (392.8-202.7 ng/ml, p<0.001) and soluble P-selectin (51.9-44.7 ng/ml, p<0.001). Von Willebrand factor (86.2-80.9 IU/ml) and beta-thromboglobulin (279.1-262.4 IU/ml) did not change significantly. Our findings show that a person's ordinary daily routine contributes to platelet activation and aggregation, and that these can be reduced by supine rest. This has methodological implications for studies involving measures of platelet activation and aggregation, and also suggests a mechanism by which bed rest in a calm environment may contribute, however slightly, to the management of acute coronary syndromes.

Biomarkers↗
PubMed2006

Efficacy of extracorporeal shockwave lithotripsy with patients rotated supine or rotated prone for treating ureteral stones: a case-control study.

PURPOSE: To improve the therapeutic efficacy of extracorporeal shockwave lithotripsy (SWL) for ureteral stones by attempting semilateral/rotated approaches. There has been no study that shows the advantage of rotated positions. PATIENTS AND METHODS: Two hundred forty-eight (group 1) and 156 (group 1R) patients with proximal-ureteral stones were treated by the Dornier Lithotriptor U15/50 in the supine and rotated-supine position, respectively. When residual calculi remained in the middle-distal ureter, group 1 subjects underwent subsequent sessions in the ordinary prone position, and Group 1R patients were treated in the rotated-prone position. Sixty-two (group 2) and 60 (group 2R) patients with primary middle-ureteral stones were treated in the prone and rotated- prone position, respectively, while 110 (group 3) and 98 (group 3R) patients with distal-ureteral stones were treated in the prone and rotated-prone position, respectively. RESULTS: Although the stone-free rate was not different in group 1 (94.8%) and 1R (97.4%), the number of sessions required for Group 1R patients to be stonefree (mean 1.49) was less than for Group 1 patients (mean 1.74; p=0.023). Group 1R patients tolerated a higher shockwave intensity than group 1 patients for sessions in the proximal ureter (p=0.042). The stone-free rate for Groups 1 and 1R for booster sessions in the middle- distal ureter was 85.4% and 100%, respectively (p=0.059). The stone-free rate for groups 2R (95.0%) and 3R (98.0%) was higher than that for groups 2 (83.9%) and 3 (89.1%) (p=0.046; p=0.011). CONCLUSION: These effortless modifications bring about a superior outcome when treating ureteral calculi with SWL.

Adult↗
PubMed2005

The lithotomy versus the supine position for laparoscopic advanced surgeries: a historical review.

Laparoscopic advanced surgery has been taught in many institutions in the United States. Initially, proctoring for the laparoscopic technique was performed by European surgeons; therefore, the lithotomy position was suggested as the preferred approach. Many American and European surgeons have adopted the supine position. Laparoscopy initially entered the clinical realm in the field of gynecology. Albert Decker, at the Knickerbocker and Gouverneur Hospital in New York, performed culdoscopy as early as 1928. This was done in the "knee-chest" position without the use of pneumoperitoneum. Raoul Palmer, at the Hopital Broca in Paris, popularized "colposcopie," utilizing pneumoperitoneum, with the patient in the lithotomy position. Laparoscopy then advanced in Europe to the general surgery arena. As a result, patient positioning for laparoscopic procedures in Europe was performed in what is now referred to as the French position (i.e., lithotomy). Many of these procedures are modified to a side approach, or American position, when performed in the United States. There is a clear association between the dorsal lithotomy position and the development of postoperative compartment syndrome. Compartment syndrome occurs when elevated pressure in an osteofascial compartment compromises local perfusion, and often results in neurovascular damage and permanent disability. Many centers have adopted the lithotomy position for their laparoscopic advanced procedures. At our institution, however, we prefer all procedures be performed in the American position (patient supine and the surgeon at the side of the patient), since this resembles the position used for other, open surgeries. The advantage of this approach is that it eliminates the risks associated with placement of the patient in the lithotomy position.

Compartment Syndromes↗
PubMed1988

The lower oesophageal sphincter in the first trimester of pregnancy: comparison of supine with lithotomy positions.

Measurement were made of gastric pressure (GP), lower oesophageal sphincter pressure (LOSP) and barrier pressure (BrP) in the supine and lithotomy positions in 17 healthy women undergoing termination of pregnancy in the first trimester. Values in the supine position were similar to those seen in non-pregnant subjects, but there was a significant reduction in LOSP and BrP in the lithotomy position unrelated to any change in intragastric pressure. It is concluded that the lithotomy position is associated with increased risk of regurgitation in early pregnancy.

Adolescent↗
PubMed1995

Anatomical configuration of the spinal column in the supine position. I. A study using magnetic resonance imaging.

In order to clarify the anatomical configuration of the spinal column in the supine position, we have examined T1-weighted sagittal midline magnetic resonance images of the spinal column in 20 healthy volunteers (11 men, nine women) in the supine position. The mean maximum angles of decline of the lumbar spinal canal in men and women were 12.6 (SD 3.9) degrees and 13.4 (3.3) degrees in the cephalad direction, respectively. The maximum angles of incline of the upper thoracic spinal canal in men and women were 20.3 (4.0) degrees and 18.5 (2.5) degrees, respectively. The median highest points of the lumbar spinal canal in men and women were located at L4 (range L3-4 to L4) and L4 (L4), respectively. The lowest point of the thoracic spinal canal was located at T8 (T7-T9) in both men and women. We have demonstrated that both lumbar lordosis and thoracic kyphosis differ between individuals, particularly with respect to the lowest point of the thoracic spinal canal, which is located between T7 and T9.

Adolescent↗
PubMed1996

Cardiovascular and catecholamine changes induced by supine exercise and upright posture in vasovagal syncope. Comparisons with normal subjects and subjects with sympathetic denervation.

The haemodynamic and catecholamine responses to supine leg exercise were studied in vasovagal syncope (n = 10), pure autonomic failure (n = 10) and in control (n = 10) subjects. With exercise, blood pressure increased in controls; with a smaller rise in vasovagal syncope, and a substantial fall in pure autonomic failure. Heart rate increased similarly in controls and vasovagal syncope, but less in pure autonomic failure. The increase in cardiac index was less in controls and pure autonomic failure than vasovagal syncope; the fall in systemic vascular resistance was greatest in pure autonomic failure, but also fell more in vasovagal syncope than controls. Plasma noradrenaline levels increased in controls; with a smaller rise in vasovagal syncope and no increase in pure autonomic failure. Plasma adrenaline levels increased in vasovagal syncope only. The blood pressure responses to standing before and after exercise were similar in controls and vasovagal syncope, with no postural blood pressure fall; in pure autonomic failure there was a greater postural blood pressure fall post exercise. In conclusion, with supine exercise, blood pressure rose in controls and vasovagal syncope, and fell in pure autonomic failure. Systemic vascular resistance fell more in vasovagal syncope and pure autonomic failure, than controls. Noradrenaline responses differed and adrenaline rose in vasovagal syncope only. Standing post exercise did not induce syncope in vasovagal syncope, but increased postural hypotension in pure autonomic failure. There are clear differences in response to exercise in vasovagal syncope and pure autonomic failure. The differences between vasovagal syncope and control subjects suggest an underlying abnormality which may predispose to vasodepression in subjects with vasovagal syncope.

Adult↗
PubMed1992

Preserved left ventricular function during supine exercise in patients after orthotopic cardiac transplantation.

Cardiac denervation may affect cardiovascular responses during exercise in patients after orthotopic cardiac transplantation. In 17 such patients, haemodynamic responses and left ventricular function were examined by radionuclide ventriculography during and after supine exercise, at an average of 17.1 +/- 2.6 months after surgery. Data were also obtained during 'volume loading' brought about by leg elevation before exercise. Results were compared with those of six normal controls. At rest, heart rate was significantly faster among transplant patients than among controls (P less than 0.0003). No significant inter-group differences in changes in cardiovascular parameters were found between the two groups during leg elevation. During exercise, heart rate in transplant patients rose at a significantly slower rate than controls (P = 0.0001), but similar increases in ejection fraction, stroke volume and cardiac output were observed among transplant patients and controls. Decline in heart rate (P = 0.0001), ejection fraction (P = 0.0007) and cardiac output (P = 0.0001) was significantly slower in transplant patients during recovery. Although there were differences in rates of increases in heart rate between transplant patients and controls during supine exercise, there were no inter-group differences in increases in cardiac output and ejection fraction and changes in haemodynamic responses and left ventricular volumes.

Adult↗
PubMed1994

Blood pressure responses in Japanese and Swedish children in the supine and standing position.

We investigated the cardiovascular responses to active standing in Swedish and Japanese pre-pubertal children using non-invasive continuous beat-to-beat finger blood pressure (BP) monitoring. Seventy-eight Swedish (7-12 years) and 53 Japanese children (6-12 years) were examined. There were no significant differences in body weight or height between the two groups (total group). Finger blood pressure and heart rate were continuously recorded in the supine position and during standing. Supine BP was significantly higher in Swedish compared to Japanese children (115/65 vs 98/50 mmHg, P < 0.001), and Swedish children showed a significantly larger initial BP drop upon rising (-28/15 vs - 14/ -10 mmHg, P < 0.05) and a larger increment of heart rate (39 +/- 10 vs 29 +/- 8 beats. min-1, P < 0.05). There were, however, no differences in the blood pressure and heart rate changes in the following steady state period (2-3 min) between the two groups. These results suggest that Swedish pre-pubertal children have a higher basal blood pressure and enhanced cardiovascular autonomic responses, such as pronounced baroreflex receptor sensitivity and vasoconstrictor mechanisms. These differences in the two cohorts were not related to body dimensions or degree of maturation, indicating that autonomic functions in the cardiovascular system largely depend on genetic factors and environmental variables.

Anthropometry↗
PubMed1998

Description of movement patterns of young adults moving supine from the foot to the head of the bed.

BACKGROUND AND PURPOSE: The purpose of this study was to describe the movement patterns (MPs) in young adults moving supine from the foot to the head of a bed. SUBJECTS: Thirty-six young adults, aged 19 through 44 years, participated in this study. METHODS: Subjects were videotaped performing 10 trial of moving in bed. The MPs of 3 body regions were described and categorized. RESULTS: Six MP categories were developed for the axial region, 8 MP categories were developed for the upper extremities, and 6 MP categories were developed for the lower extremities. Kappa values ranged from .81 to .90 for the 3 body regions, Fifty-nine different combinations of MPs were observed. The most common combination of MPs occurred in 21.2% of the trials, 3 times more frequently than any other combination. CONCLUSION AND DISCUSSION: A variety of MPs are used by young adults for moving from the foot to the head of the bed. A symmetrical pattern of sitting up and pushing with both hands and both feet was found to be the most common pattern. [Cohen BG, Cardillo ER, Lugg D, et al. Description of movement patterns of young adults moving supine from the foot to the head of the bed.

Adult↗
PubMed2000

Supine cephalometric study on sleep-related changes in upper-airway structures in normal subjects.

The purpose of this study was to examine sleep-related changes in the upper airway and surrounding structures including the mandible, hyoid bone, and cervical vertebra in normal subjects using lateral cephalograms in the supine position. Eleven male and nine female healthy adults participated in this study. Supine cephalograms were taken at end-expiration during wakefulness and in stage 1-2 non-rapid-eye-movement (NREM) sleep judged from the electroencephalogram and respiratory monitoring. A paired t-test was used to compare differences between the values measured during wakefulness and sleep. A significant increase in the amount of jaw opening was observed during sleep. The anteroposterior width of the upper airway was significantly decreased during sleep. The distances between the hyoid bone and the mandibular symphysis and between the cervical vertebra and the hyoid bone were significantly decreased during sleep. Consequently, the distance between the cervical vertebra and the mandibular symphysis was significantly decreased. These results suggest that the upper-airway dimension is significantly decreased and relatively small structural changes are induced during sleep in normal subjects.

Adult↗
PubMed2000

Sequential changes of arterial oxygen tension in the supine position during one-lung ventilation.

UNLABELLED: To investigate how surgical positions affect the severity and progress of hypoxemia during one-lung ventilation (OLV), we studied 33 adult patients undergoing right thoracotomy with left OLV. The patients were divided into three groups according to the positions during surgery as follows: the supine position (SP) group (n = 11), the left semilateral decubitus position (LSD) group (n = 9), and the left lateral decubitus position (LLD) group (n = 13). Analysis of arterial blood gases was sequentially determined every 5 min for 30 min during OLV (fractional ratio of inspiratory oxygen = 1.0) in each position. OLV was promptly terminated and switched to bi-lung ventilation if Spo2 declined to 90%. Pao2 progressively decreased with time in all three groups (P < 0.01). The incidence of termination of OLV within 30 min was higher in the SP group (82%), compared with that in the LSD (11%) and LLD (8%) groups (P < 0.01). Final Pao2 (65+/-12 mm Hg, mean +/- SD, P < 0.01 versus LLD, P < 0.05 versus LSD) and SaO2 (91%+/-4%, P < 0.01 versus LLD and LSD) at the termination of OLV in the SP group were the lowest. There was no difference between these values in the LSD and LLD groups (128+/-54 mm Hg, 96%+/-2%, and 167+/-69 mm Hg, 97%+/-4%, respectively) 30 min after the start of OLV. The time for Pao2 to decrease to 200 mm Hg calculated from each regression curve was 354 s in the SP group, 583 s in the LSD group, and 798 s in the LLD group. The time for Pao2 to decline to 100 mm Hg was 794 s in the SP group. In the regression curves of the LSD and LLD groups, the Pao2 did not decrease to 100 mm Hg. Heart rate was slow at baseline in the SP group (P < 0.05 versus LSD), but other hemodynamic variables did not differ among the three groups throughout this study. The LSD was as effective as the LLD in avoiding life-threatening hypoxemia during OLV. IMPLICATIONS: Close observation and prompt counteractions including termination of one-lung ventilation (OLV) are crucial for patients under OLV in the supine position, because life-threatening hypoxemia frequently occurs approximately 10 min after starting OLV, even under 100% oxygen inhalation. The left semilateral decubitus position was as effective as the left lateral decubitus position in avoiding life-threatening hypoxemia during OLV.

Blood Gas Analysis↗
PubMed1995

Supine lung clearance of Tc-99m DTPA and HMPAO aerosols.

The speed of Tc-99m DTPA/HMPAO radioaerosol clearance from the lungs that is represented as a slope from lungs to blood was measured in 23 male normal controls using commercial lung radioaerosol delivery units in the supine position in order to avoid the influences of gravity. The right lung was selected and three regions of interest were created for equal subdivisions of the upper, middle, and lower third. The results show that the clearance of Tc-99m DTPA/HMPAO aerosols in the upper lung is slowest. The differences between upper and lower lungs for Tc-99m DTPA/HMPAO aerosol clearances are significant. The clearance of Tc-99m DTPA aerosols was significantly faster than those of Tc-99m HMPAO in any region. The authors conclude that, although the effect of gravity disappears in the supine position in our study, the differences of aerosol clearance in different regions are still significant. Lipophilic Tc-99m HMPAO aerosols were slower than those of hydrophilic Tc-99m DTPA, which suggests there are at least two different mechanisms.

Aerosols↗
PubMed1995

Supine and prone SPECT Tc-99m MIBI myocardial perfusion imaging for dipyridamole studies.

Aartifactual inferior wall defects of perfusion are a source of frequent concern during TI-201 exercise stress redistribution SPECT imaging in the supine position. These artifactual changes also affect Tc-99m sestamibi dipyridamole myocardial perfusion studies with supine SPECT yielding a specificity of only 58% for right coronary artery (RCA) disease. Complementary SPECT prone imaging will enhance this specificity for inferior wall abnormalities to 79% (P < 0.05) and is recommended for more accurate assessment of RCA stenosis, whether the patient challenge is pharmacological or by exercise.

Adult↗
PubMed2001

Assessment of the position of the distal portion of the ulna in lateral projection radiographs of the wrist: analysis of the influence of pronation-supination and flexion-extension on the pisoscaphoid and the ulnotriquetral distances: a cadaver study.

RATIONALE AND OBJECTIVES: Accurate assessment of the distal radioulnar joint is of paramount importance for the detection of possible dislocation or subluxation. Using a cadaveric model, the authors attempted to establish a quantitative method that would allow identification of normal and abnormal distal radioulnar joint anatomy on well-positioned and rotated conventional radiographs. METHODS: Four cadaveric wrists, in which subsequent sectioning confirmed the absence of disease, and one cadaveric wrist with a circumscribed lesion of the triangular fibrocartilaginous complex were studied. Defined movements in flexion and extension (+/- 10 degrees, 20 degrees, 30 degrees ) and in pronation and supination (+/- 10 degrees, 20 degrees, 30 degrees ) as well as combined flexion/extension and pronation/supination were performed. The ulnotriquetral and the pisoscaphoid distances were assessed in each position. Correlation with cryosections was achieved. RESULTS: A strong linear correlation between the degree of pronation or supination and the pisoscaphoid and ulnotriquetral distances was noted. Flexion and extension produced no significant effect on the pisoscaphoid distance, but a defined shift of the ulnotriquetral distance occurred with increasing flexion and extension. CONCLUSIONS: If all parameters are taken into account, this correlation aids in estimating the degree of possible malpositioning of the wrist during radiography and the degree of subluxation of the distal radioulnar joint. Tabular data with parameters to correct for instances of malrotated images and to estimate the extent of dislocation or malrotation of the distal radioulnar joint are provided.

Cadaver↗
PubMed1991

Inheritance of blood pressure and haemodynamic phenotypes measured at rest and during supine dynamic exercise.

Thirty-two pairs of monozygotic and 21 pairs of dizygotic male twins aged between 18 and 31 years were studied. Blood pressure was measured and Doppler echocardiography at the level of the aorta was performed in resting conditions and at two levels of supine submaximal bicycle exercise (at a fixed work load of 60 W and at a work load corresponding to a heart rate of 110 beats/min). In resting conditions, a genetic component in the variability of systolic and diastolic blood pressure was found; during submaximal supine exercise only a minor genetic effect was observed. At rest, genetic variance was shown for left ventricular outflow haemodynamics and for peripheral vascular resistance. However, during exercise, the transmissible effect on haemodynamics and peripheral resistance was small.

Adult↗
PubMed2001

Marginal plafond impaction in association with supination-adduction ankle fractures: a report of eight cases.

In five years, approximately 800 ankle fractures were seen at the authors' institution, forty-four (5 percent) of which were of the supination-adduction pattern. Nineteen of these injuries had displaced vertical medial malleolus fractures, of which eight (42 percent) showed marginal impaction of the tibial plafond. All eight patients underwent open reduction and internal fixation with elevation of the impacted articular component and had good to excellent functional outcome with no arthritis on radiograph at the time of the most recent follow-up. The index of suspicion of marginal impaction of the tibial plafond should be high when treating supination-adduction pattern ankle fractures with displaced medial malleolus.

Adult↗
PubMed2003

Tension pneumocephalus after craniotomy in supine position.

Tension pneumocephalus has been reported frequently after posterior fossa surgery, mostly in procedures done in the sitting position. Though uncommon, tension pneumocephalus is a life-threatening complication that requires urgent diagnosis and treatment. It is rare for this complication to occur after neurosurgical procedures done in the supine position. The authors report a case of an adult patient diagnosed with craniopharyngioma who developed tension pneumocephalus following craniotomy in the supine position.

Adult↗