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PubMed1991

[Dynamic changes in superior vena caval configuration based on posture].

To noninvasively study positional effects on superior vena caval configuration in humans, endoscopic ultrasonography was performed in 34 subjects including 20 with lung cancer, 5 with esophageal cancer and 9 with other diseases. None of the these subjects had cardiovascular involvement or respiratory dysfunction. A fiberoptic esophagoscope equipped with a 7.5 MHz linear array ultrasonic transducer at its tip (EPE-703, Toshiba-Machida) was used for the study. The actual movement of the superior vena cava (SVC) was clearly observed at the hilar level in all cases. During the cardiac cycle the anteroposterior diameter of the SVC was observed to reach a maximum at the atrial systole and reached a minimum at the late ventricular systole. With respiration, the SVC increased in diameter during inspiration and decreased during expiration. Moreover M and B mode figures of the SVC wall were recorded in left (LLD) and right decubitus (RLD) and supine position (SUP) in 34 subjects. On quiet ventilation of FRC level the diameter of the SVC was unchanged. Both the maximal and minimal diameters of the SVC, which were corrected for body surface area (BSA), were 11.3 +/- 0.3 (mean +/- SEM) mm/m2 and 9.8 +/- 0.3 mm/m2 in right lateral decubitus position, 9.4 +/- 0.3 and 7.9 +/- 0.3 in the supine position, 8.5 +/- 0.3 and 7.1 +/- 0.3 in the left lateral decubitus position, respectively. The size of the SVC was the greatest in the right lateral decubitus position and was the smallest in left lateral decubitus position (p less than 0.01, multiple comparison). It was suggested that the geometry of the SVC is influenced by thoracic pressure and gravity and that it behaves very similarly to pulmonary vascular vessels as a collapsible tube.

Adult↗
PubMed1986

[Postural effects in the jugular phlebogram in patients with complete absence of the left pericardium].

To elucidate the function of the pericardium, alterations in jugular phlebograms, intracardiac pressures and cardiac volumes induced by postural changes were examined in seven patients with complete absence of the left pericardium. Ten patients with ischemic heart disease were studied as controls. Jugular phlebograms in patients with complete absence of the left pericardium showed decreased depths of the x descent and the tall v waves followed by the deep y descents (M-shaped pattern) in the supine position. These jugular abnormalities were exaggerated in the left lateral decubitus position. By contrast, the jugular phlebograms tended to return to normal, but remained abnormal in the right lateral decubitus position. Right atrial pressure curves showed similar postural effects. However, the jugular phlebograms and right atrial pressure curves in patients with ischemic heart disease were not altered by postural changes. The characteristic alterations of the jugular phlebograms are useful indicators for diagnosing complete absence of the left pericardium. The lack of a prompt decrease in pericardial pressure during ventricular ejection due to the absence of the pericardium is one of the causes of a decreased depth of the x descent in pericardial defect. However, this cannot explain the postural alteration of the jugular phlebogram. Another possible mechanism is the decreased excursion of the tricuspid ring during systole. As indicated in our previous report, there is anterior movement of the cardiac apex during systole in cases of pericardial defect, which is exaggerated in the left lateral decubitus position and decreased in the right lateral decubitus position due to the lack of normal pericardial support. This anterior swinging motion may inhibit the descent of the tricuspid ring toward the apex, resulting in a decreased depth of the x descent of the jugular phlebogram and the right atrial pressure curve and their postural alterations. The right ventricular volume as calculated from cardiac computerized tomography and the right ventricular end-diastolic pressure were not altered significantly by postural changes in the control cases. These indices increased to a greater extent in the left lateral decubitus position than in other postures in cases with pericardial defects.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1993

The effect of selective drainage positions on oxygen saturation in obese patients after upper abdominal surgery.

The obese patients undergoing upper abdominal surgery are at particularly high risk to develop postoperative pulmonary complications, and hypoxemia is one of the most common ones reported. During the initial postoperative period, they are often advised to maintain a semi-sitting position to optimize oxygenation. Although chest physical therapy usually avoids a Trendelenburg position, no published data indicate this position as being able to induce desaturation in obese patients following upper abdominal surgery. We studied fifteen adult obese patients without cardiopulmonary disease undergoing upper abdominal surgery. All patients were tested for 5 minutes during the first 3 postoperative days in each of 3 positions: semi-sitting, bed-flat lateral decubitus, and 15 degrees of Trendelenburg lateral decubitus positions. A statistically significant difference in oxygen saturation related to position was found only on the first postoperative day between semi-sitting and bed-flat lateral decubitus positions. The difference in mean SaO2 value between these 2 positions, however, was only 0.88%; and no significant correlation between the magnitude of obesity and the mean SaO2 difference was found. Although arterial oxygen saturation demonstrated statistically significant daily improvement during the first 3 postoperative days, the mean SaO2 values for any 2 consecutive days differed by less than 0.78%. Thus, in obese patients following upper abdominal surgery, 15 degrees of Trendelenburg lateral decubitus and bed-flat lateral decubitus positions do not induce clinically significant desaturation and can be used if necessary and appropriate. In obese patients with borderline oxygenation, supplemental oxygen used postoperatively can maintain adequate oxygenation and allow aggressive positioning.

Abdomen↗
PubMed1998

Emergency tracheal intubation of patients lying supine on the ground: influence of operator body position.

PURPOSE: To evaluate the influence of operator body position during emergency intubation of patients lying on the ground. METHODS: This study was carried out in the prehospital setting by French mobile intensive care units. Two operator body positions (left lateral decubitus and kneeling) for emergency intubation of patients lying supine on the ground were compared in a observational prospective study. Each operator completed a questionnaire regarding conditions of intubation after patient completion. RESULTS: The incidence of laryngoscopic difficulty was lower in the left lateral decubitus group compared to the kneeling group (11.1% vs 26.9% respectively; P < 0.01). The number of attempts required for successful intubation was (P < 0.05) higher in the kneeling group than in the left lateral decubitus group. CONCLUSION: Emergency tracheal intubation of supine patients on the ground may be greatly facilitated by the use of the left lateral decubitus position of the operator.

Adolescent↗
PubMed1995

[The effect of mechanical ventilation, thoracotomy, and one-lung respiration on intrapulmonary perfusion distribution. An animal experimental study].

The physiological pattern of regional pulmonary blood flow is mainly determined by the relationship of pulmonary arterial, venous, and alveolar pressures. Changes in alveolar pressure and pulmonary geometry may therefore be expected to influence regional perfusion, which is a key determinant of pulmonary gas exchange. Unilateral thoracotomy is usually performed with the patient in the lateral decubitus position. The present study examined the influence of mechanical factors on regional pulmonary blood flow distribution in rabbits in the lateral decubitus position during normoxia and unilateral hypoxia. METHODS. Anaesthetised white New Zealand rabbits (n = 8) weighing 2200-3900 g (mean = 2860 g) received central venous injections of radioactive microspheres while in the left lateral decubitus position during spontaneous breathing (SB) and during mechanical ventilation (two-lung ventilation, 2LV), under closed (2LVC) and open chest (2LVT) conditions, as well as during unilateral hypoxia of the nondependent lung induced by nitrogen inflation (1LVN) or atelectasis (1LVA). The method used for one-lung ventilation (1LV) has been previously described in detail. Arterial, central venous, and pulmonary arterial pressures were recorded continuously. Lungs were excised, dried in the inflated state, and cut into 16 sagittal slices, which were further divided into lobar components, the lower lobes into center and periphery. The radioactivity of each specimen was measured in a gamma-counter; perfusion of the individual tissue specimens was quantified using the software program MIC III. The Friedman test followed by paired comparisons according to Conover was used for statistical analysis of differences between the experimental phases. Perfusion of central and peripheral parts of isogravitational slices was compared by use of the Wilcoxon matched pairs test. Values are given as means +/- SE; the level of significance was P < 0.05 unless otherwise indicated. RESULTS AND DISCUSSION. Haemodynamic parameters did not differ significantly between the experimental phases (Table 1). Compared to 2LV, a significant increase in venous admixture (P < 0.05) and a corresponding decrease in PaO2 (P < 0.01) were observed during 1LV. This effect was significantly more pronounced during 1LVA as compared to 1LVN (P < 0.01). Since inspiratory pressure was kept constant throughout the experiments, moderate respiratory acidosis developed during both phases of 1LV. Regional perfusion (Qr) of the nondependent lung was slightly reduced during 2LVC compared to SB and 2LVT. One-lung ventilation induced a significant decrease in perfusion of the hypoxic lung (P < 0.001 1LVN, 1LVA vs. SB,2LVC,2LVT). In accordance with the data obtained from blood gas analysis and oximetry, this effect was more pronounced during N2 insufflation than during atelectasis (P < 0.01 1LVN vs. 1LVA). Among the factors that may account for this effect, PaCO2 did not differ significantly between both phases of 1LV. During N2 insufflation PO2 at the hypoxia-sensitive site is lower than during atelectasis, where it equals mixed-versus PO2 (PvO2). The difference in local PO2 is unlikely, however, to have caused the changes in regional perfusion between 1LVN and 1LVA, since PvO2 was as low as 40 mmHg during 1LVA and the pulmonary vascular response to hypoxia has been found to reach its maximum in this PO2 range [2, 11]. Enhanced redistribution of regional perfusion during 1LVN as compared to 1LVA is therefore most likely attributed to differences in alveolar pressure and pulmonary geometry. Apart from a radial perfusion gradient in the right lower lobe during 2LVC and 2LVT, no isogravitational Qr gradients were observed. CONCLUSION. We conclude that controlled mechanical ventilation in the lateral decubitus position causes only minor changes in vertical blood flow distribution.

Animals↗
PubMed1994

Effects of supine and lateral recumbent positions on pulmonary venous flow in healthy subjects evaluated by transesophageal Doppler echocardiography.

OBJECTIVES: This study attempted to evaluate the effects of supine and lateral recumbent positions on pulmonary venous flow by transesophageal Doppler echocardiography in healthy subjects. BACKGROUND: Although transesophageal echocardiographic examination is usually performed with the patient lying in the left lateral decubitus or supine position, little attention has been paid to the effects of these positions on pulmonary venous flow. METHODS: We performed pulsed Doppler transesophageal echocardiography of the left and right pulmonary veins in 16 normal subjects as they lay in the left and right lateral decubitus and supine positions. RESULTS: Data are reported as mean value +/- SD. Adequate recordings were obtained in 12 subjects (75%). In the left pulmonary vein, peak systolic velocity and time-velocity integral of systolic flow increased significantly in the left compared with the right lateral decubitus position (56 +/- 12 vs. 44 +/- 13 cm/s, p < 0.05, and 15 +/- 4 vs. 9 +/- 4 cm, p < 0.05, respectively). In the right pulmonary vein, peak systolic velocity and time-velocity integral of systolic flow decreased significantly in the left compared with the right lateral decubitus position (38 +/- 10 vs. 48 +/- 9 cm/s, p < 0.05, and 9 +/- 2 vs. 12 +/- 2 cm, p < 0.05, respectively). There were no significant differences between positions in peak diastolic flow velocity, time-velocity integral of diastolic flow or peak velocity of flow reversal at atrial contraction. CONCLUSIONS: Pulmonary venous systolic peak velocities and time-velocity integrals of systolic flow increase when the pulmonary venous recording is from the recumbent subject's lower side. Therefore, the effects of position should be considered in evaluating left ventricular diastolic function by transesophageal Doppler echocardiography.

Adult↗
PubMed2006

Quantitative analysis of the velocity and synchronicity of diaphragmatic motion: dynamic MRI in different postures.

The objectives of this study were to assess the relationship between right and left hemidiaphragmatic motions during breathing in normal subjects and to investigate alterations in lung motion with changes in posture, using dynamic magnetic resonance (MR) imaging. Imaging was conducted with a 1.5-T MR scanner using fast imaging employing steady-state acquisition with a torso coil. Eight healthy subjects were instructed to breathe from end-inspiration to end-expiration as slowly and as deeply as possible. Imaging and breathing were started together to afford sequential images on the coronal plane. Imaging sequences were performed in supine, prone, left lateral decubitus and right lateral decubitus postures. The component of movement of the most cephalic point in the cephalocaudal axis was measured, and the diaphragmatic excursion (maximum hemidiaphragmatic displacement), synchrony and velocity of the right and left hemidiaphragmatic motions were calculated during the expiratory phase and the inspiratory phase, respectively. Excursion was greater in the right hemidiaphragm in most postures, except the left lateral decubitus. In supine and prone postures, both hemidiaphragms moved synchronously in both inspiratory and expiratory phases. In both lateral decubitus postures, the hemidiaphragms moved asynchronously with different velocities in the expiratory phase but with the same velocities in the inspiratory phase. The method described here allowed the assessment of diaphragmatic motions. Motions in the right and left hemidiaphragms changed with posture. In addition, diaphragmatic motion differed between expiratory and inspiratory phases. This study suggests the further potential of dynamic MR imaging for the evaluation of pulmonary functions or deficiencies.

Adult↗
PubMed2000

Effects of posture on sympathetic nervous modulation in patients with chronic heart failure.

We investigated which recumbent position is preferred by patients with chronic heart failure (CHF) and whether sympathetic nervous modulation differs in three recumbent positions. We assessed 12 patients with CHF by spectral analysis of heart-rate variability and measurement of plasma norepinephrine concentrations. The right lateral decubitus position was preferred for significantly longer periods than the left lateral decubitus and supine positions. Sympathetic nervous modulation was most attenuated in the right lateral decubitus position. The right lateral decubitus position preferred by patients with CHF may be a self-protective mechanism to control increased sympathetic nervous modulation.

Heart Failure↗
PubMed2002

Trepopnea in patients with chronic heart failure.

This article will review the recumbent positions of patients with chronic congestive heart failure. The time for the right lateral decubitus position was two-fold longer than that for the supine and left lateral decubitus positions. Sympathetic nervous modulation was most attenuated and parasympathetic tone was most augmented in the right lateral decubitus position. The underlying mechanisms why heart failure patients prefer this position will be discussed. In conclusion, the right lateral decubitus position preferred by patients with chronic congestive heart failure may be a self-protecting mechanism to augment cardiac output and to attenuate the imbalance of cardiac autonomic nervous activity.

Chronic Disease↗
PubMed2000

[The characteristics of the mechanical activity of the respiratory muscles during the diaphragmatic respiration technic].

UNLABELLED: Noteworthy among breathing training techniques is so-called diaphragmatic breathing. In spite of the technique's name, however, little is known of the functional characteristics of this ventilatory method. OBJECTIVE: To asses the mechanics of respiratory muscles, particularly diaphragm muscles, during diaphragmatic breathing in patients with severe chronic obstructive pulmonary disease (COPD). METHODS: Ventilatory pattern and respiratory pressures (abdominal [Pga], intrathoracic [Pes] and transdiaphragmatic [Pdi]) were studied in 10 patients with severe COPD in stable phase (age 69 +/- 6 years, FEV1 33 +/- 12% ref) at baseline and during deep breathing with spontaneous muscle recruitment (SMR) and during breathing training. Measurements were taken with the patient seated and in supine decubitus position. RESULTS: In seated position ventilatory pattern was similar with SMR and during breathing training. Mean Pdi during airflow, however, was greater during breathing training than with SMR (34.8 +/- 8.0 and 29.3 +/- 9.3 cmH2O, respectively, p < 0.05) for similar levels of Pes. Mechanical effectiveness of the diaphragm expressed as Vt/Pdi) was less during breathing training, however (36.1 +/- 10.4 and 49.5 +/- 15.8 cc/cmH2O, p < 0.05), with no changes in overall efficacy of respiratory muscles (Vt/Pes). In supine decubitus position, ventilatory patterns of SMR and breathing training were similar, although Vt and T1 were slightly higher in the latter (1,065 +/- 305 vs. 1,211 +/- 314 cc, p < 0.01; and 2.76 +/- 1.32 vs. 3.07 +/- 1.23 sec, p < 0.05). Pdi was also higher during breathing training (29.7 +/- 10.2 and 38.0 +/- 10.5 cmH2O, p < 0.05), although accompanied in this case by a higher Pes (21.2 +/- 7.5 to 26.4 +/- 8.4 cmH2O, p < 0.005). In supine decubitus position, the effectiveness of both diaphragm muscles and respiratory muscles overall was similar for both ventilatory modes. CONCLUSIONS: Breathing training truly involves greater use of the diaphragm, both in seated and supine decubitus positions. Breathing training does not provide greater ventilatory efficacy than SMR, however, in COPD patients.

Aged↗
PubMedDate not supplied

[Repercussion on the hemodynamic measurements across a Swan-Ganz catheter with the postural changes].

AIM: Usually hemodynamic measures are done with the patient in dorsal decubitus and the bedside at 0 degrees. Our aim has been to evaluate the influence that postural changes has in the hemodynamic measures which were carried out with a pulmonary artery catheter, so as called Swan-Ganz. MATERIAL AND METHOD: It's a prospective study. The same patient is control group and study group. There were done tree consecutive measures in each patient. Firstly in dorsal decubitus, then right lateral decubitus and finally in left lateral decubitus. Before doing the measures after change of posture a thirty minutes period was left in order to stabilise the hemodynamical flow. The items of study were, a part of demographic ones, cardiac index, pulmonary artery systolic pressure, pulmonary artery diastolic pressure, pulmonary artery mean pressure, pulmonary artery occlusion pressure, right atrial pressure, systolic arterial pressure, diastolic arterial pressure, mean arterial pressure and heart rate. 28 patients were included in the study. RESULTS: The age average was 62.5 years (27.05-67.05); a 78.6% were male. Who had a NEMS average of 42.4 (39.9-44.9). No difference was found between hemodynamic measures in the different postures. CONCLUSIONS: Postural changes in stable patients have no influence in pressures and other hemodynamic variables measures.

Adult↗
PubMed1998

Visual input effect on EMG activity of sternocleidomastoid and masseter muscles in healthy subjects and in patients with myogenic cranio-cervical-mandibular dysfunction.

This study was conducted in order to determine the input visual effect on electromyographic (EMG) activity of the sternocleidomastoid and masseter muscles in the supine and lateral decubitus positions. The study was performed on 22 patients with myogenic cranio-cervical-mandibular dysfunction (CMD) and 18 healthy subjects. EMG activity at rest and during swallowing of saliva and maximal voluntary clenching was recorded in the supine and lateral decubitus positions in the following conditions: 1. with eyes open; and 2. with eyes closed after 5 minutes in a dark room. A significant decrease of EMG activity at rest with closed eyes in both groups was observed in the sternocleidomastoid (lateral decubitus position) and in the masseter muscle (supine position). During swallowing of saliva a significant decrease of EMG activity with closed eyes was observed only in the sternocleidomastoid muscle (lateral decubitus position) in healthy subjects. During maximal voluntary clenching any significant differences were observed upon variation in the visual input. The significant change in EMG activity, mainly observed at rest, suggests that the visual input effect is weak. The absence of a significant change in EMG activity during maximal voluntary clenching upon variation in the visual input could be clinically relevant in patients with myogenic CMD who habitually brux.

Adolescent↗
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↗
PubMed1994

Radiographic evaluation of instability in spondylolisthesis.

STUDY DESIGN: The amount of intervertebral motion seen during dynamic radiography when imaged with the patient in the standing position was compared with that obtained with the patient in the lateral decubitus position. SUMMARY OF BACKGROUND DATA: Regarding analysis of spondylolisthesis, whether flexion/extension radiographs should be obtained with the patient in the lateral decubitus or standing position has been anecdotal. METHODS: Fifty consecutive adult patients with spondylolisthesis underwent flexion/extension lumbar spine radiographs in both positions. Abnormal motion was considered above 12 degrees dynamic angulation or 8% translation. RESULTS: Thirty-one of 50 patients displayed abnormal translation. Of these, 18 had abnormal motion only when they were examined in the lateral decubitus position and not when standing. Nine displayed excessive motion in both positions. Only four displayed more translation while standing. There was no statistical difference in the evaluation of dynamic angulation based on patient position. Neither age, degree of slip, listhetic level, nor type of spondylolisthesis correlated with abnormal motion. CONCLUSIONS: When spondylolisthesis is being analyzed, to maximize motion, flexion/extension radiographs should be obtained in the lateral decubitus position.

Adult↗
PubMed1997

The effect of position on autonomic nervous activity in late pregnancy.

We investigated the effect of three different recumbent positions on autonomic nervous activity in late pregnancy. Thirty pregnant and 24 nonpregnant aged-matched women were studied, and measures of heart rate variability in both time and frequency domains were compared using supine, right and left lateral decubitus positions. In the nonpregnant women, the normalised high-frequency power was greatest in the right lateral decubitus position. In the pregnant women, the normalised high-frequency power was lowest and the low/high-frequency power ratio was greatest in the supine position. Both the percentage decrease of normalised high-frequency power and the percentage increase of low/high-frequency power ratio in the supine and right lateral positions were greater than those in the left lateral position. For women in late pregnancy, the left lateral decubitus position may be beneficial because cardiac vagal activity is least suppressed and cardiac sympathetic activity is least enhanced. Aortocaval compression might be the mechanism underlying the change in cardiac autonomic nervous activity when supine and right lateral decubitus positions are assumed in late pregnancy.

Adult↗
PubMed1998

Unilateral spinal anaesthesia with hyperbaric bupivacaine.

BACKGROUND: The dosage of local anaesthetic and the time the patient must be kept in the lateral decubitus position for a unilateral spinal anaesthesia is not known. The aim of this study was to determine the ideal dosage of hyperbaric bupivacaine and the time required for the lateral decubitus position for a unilateral spinal block. METHODS: Ninety patients who were scheduled to receive spinal block for surgery in the lower extremity were randomised into 9 groups (n = 10). The spinal block was performed through the L4-L5 intervertebral space with the patient in the lateral decubitus position. Patients in groups Ia, Ib, Ic; IIa, IIb, IIc; IIIa, IIIb, IIIc received 1.5 ml of 0.5%, 2 ml of 0.5%, and 2.5 ml of 0.5% hyperbaric bupivacaine solutions, respectively. The patients were turned to the supine position for 5 min after the injection in groups Ia, IIa, IIIa, 10 min after the injection in groups Ib, IIb, IIIb, and 15 min after the injection in groups Ic, IIc, IIIc. The onset and regression of sensory and motor block were checked and compared between the dependent and non-dependent sides in each group. RESULTS: The rate of block progression of the non-dependent side was higher in the groups receiving 2.5 ml 0.5% hyperbaric bupivacaine solution than in the other groups; at the same time the level of block was higher and the duration of block was longer. The incidence of hypotension was 10-20% in these groups. In the 2 ml 0.5% hyperbaric bupivacaine solution groups, a satisfactory block level and duration of anaesthesia for surgery was obtained. The rate of block progression to non-dependent side in the groups receiving 1.5 ml of 0.5% hyperbaric bupivacaine solution was lower than the other groups, but the duration of block was shorter and the level of block was lower than the other groups. CONCLUSION: For unilateral spinal anaesthesia in lower extremity operations, 2ml 0.5% hyperbaric bupivacaine solution for operations above the knee and 1.5 ml 0.5% hyperbaric bupivacaine solution for operations below the knee and keeping the patients for 10 min in the lateral decubitus position were found to be appropriate.

Adolescent↗
PubMed1995

Gastric emptying of oil and aqueous meal components in pancreatic insufficiency: effects of posture and on appetite.

The aims of this study were to evaluate the effects of posture on gastric emptying, intragastric distribution, and satiation after a meal containing oil and aqueous phases in patients with exocrine pancreatic insufficiency. Five patients with cystic fibrosis (CF) consumed 60 ml 99mTc-labeled (V)-thiocyanate olive oil and 290 ml 113mIn-labeled diethylenetriaminepentaacetic acid soup while sitting and while lying in the left lateral decubitus position. Hunger and fullness before and after the meal were recorded. Results were compared with those obtained in 11 normal volunteers. In both postures emptying of oil was faster (P < 0.01) in CF patients. Emptying of the aqueous phase was faster (P < 0.01) in CF patients in the decubitus position. In normal subjects there was no overall difference in emptying of oil between the two postures, whereas emptying of the aqueous phase was delayed (P < 0.01) in the decubitus position. In CF patients emptying of oil was faster (P < 0.01) in the decubitus position, and emptying of the aqueous phase was only slightly faster (P < 0.05) in the sitting position. For both postures there was greater retention (P < 0.05) of oil in the proximal stomach in normal subjects than CF patients. Hunger decreased (P < 0.05) after the meal in the control subjects, but there was no change in CF patients. These results indicate that in CF patients with pancreatic exocrine insufficiency 1) gastric emptying of nonhomogenized fat is faster than normal, 2) gravity affects gastric emptying of oil, and 3) effects of a fatty meal on hunger are reduced.

Adult↗
PubMed1989

Diaphragm length adjustments with body position changes in the awake dog.

Sonomicrometry was used to measure end-expiratory length and tidal shortening of the costal and crural diaphragm in awake chronically instrumented dogs in the right lateral decubitus, standing, and sitting postures. End-expiratory length did not change significantly in standing but fell by 11.5% for the costal and by 14.4% for the crural segment in sitting, when compared with decubitus position. Tidal shortening of both segments did not change significantly in the three postures. From decubitus to sitting, diaphragmatic electromyogram (EMG) activity increased only in some dogs, not significantly for the group. The inspiratory swing of abdominal pressure was always positive in decubitus and negative in standing and sitting. In the latter two postures, abdominal pressure increased gradually during expiration and fell in inspiration, suggesting a phasic expiratory contraction of abdominal muscles. We conclude that diaphragmatic tidal shortening is maintained in the different postures assumed by the awake dog during resting breathing. It seems that the main compensatory mechanism for changes in diaphragmatic operational length is a phasic expiratory contraction of the abdominal muscles rather than an increase in diaphragmatic EMG activity.

Abdomen↗