Turkish Neurosurgery 2011 , Vol 21 , Num 4
Neurosurgery in the Sitting Position: Retrospective Analysis of 692 Adult and Pediatric Cases
Ozlem KORKMAZ DILMEN1, Eren Fatma AKCIL1, Ercan TURECI1, Yusuf TUNALI1, Mois BAHAR1, Taner TANRIVERDI2, Sabri AYDIN2, Ercument YENTUR1
1Istanbul University, Cerrahpasa Faculty of Medicine, Department of Anesthesiology and Intensive Care, 34098, Istanbul, Turkey
2Istanbul University, Cerrahpasa Faculty of Medicine, Department of Neurosurgery, Istanbul, Turkey
DOI : 10.5137/1019-5149.JTN .4974-11.0 AIM: The sitting position is routinely used in many centers, although its use remains controversial and appears to be diminishing because of the risk of venous air embolism (VAE).

MATERIAL and METHODS: This is a retrospective analysis of 601 adult and 91 pediatric cases underwent neurosurgery from January 1995 through December 2010 in the sitting position. The incidence of VAE and other complications related to the sitting position has been determined. VAE was defined as a sudden and sustained decrease of end-tidal carbon dioxide (ETCO2) ≥0.7kPa.

RESULTS: The incidence of VAE in children and adults were found to be 26.3% (n=24) and 20.4% (n=123) consecutively but the difference was not significant. The incidence of positioning induced hypotension was more in adults (37.6%) compared to children (18.6%, p=0.00001). The presence of COPD (p=0.04) and ASA status (p=0.03) showed a correlation with ‘hypotension with positioning'. There was no peroperative mortality.

CONCLUSION: The study provides a significant body of data on neuroanesthesia for the sitting position and our results suggest that if the sitting position is a neurosurgical necessity it can be used with vigilant follow up throughout the procedure to detect any occurrence of VAE by ETCO2 monitoring if you do not have the chance to use more sensitive tools. Keywords : Complications, Air embolism, Monitoring, End tidal carbon dioxide, Position, Sitting

Corresponding author : Ercan Turesı, etureci@yahoo.com