TITLE:
Comparison of Clinical Problems in Thoracoscopic Esophagectomy between Prone Position with Pneumothorax Procedure and Lateral Position
AUTHORS:
Yoshihiro Kasagi, Ryu Okutani, Yukiko Komatsu, Yutaka Oda, Yoshito Yamashita
KEYWORDS:
Thoracoscopic Esophagectomy; Prone Position; Lateral Position; CO2 Pneumothorax; Oxygenation
JOURNAL NAME:
Open Journal of Anesthesiology,
Vol.3 No.3,
May
13,
2013
ABSTRACT: Study Objective: We compared the effects of intraoperative body position on blood gas and fluid
balance in patients undergoing a thoracoscopic esophagectomy as well as during
operation and postoperative laboratory data. Design: Prospective study. Setting: Operating room
and intensive care unit. Patients: ASA physical
status 1 and 2 patients (n = 26), scheduled for elective thoracoscopic
esophagectomy and immediate reconstruction under general anesthesia with
one-lung ventilation were enrolled. Interventions: Patients were assigned to either the lateral (n = 16) or prone (n = 10)
position groups based on the planned intraoperative body position. A
pneumothorax procedure was concomitantly performed only in the prone position
group. Measurements: Fluid balance,
PaO2/FIO2 ratio (P/F ratio), and maximum PaCO2 during the operation and postoperative laboratory data were analyzed. Main Results: There were no significant
differences between the groups for amount of blood loss, blood transfusion,
fluid infusion, or urine output. The P/F ratio during one-lung ventilation was
significantly higher in the prone than the lateral position group (379 ± 122 vs.
297 ± 67 mmHg, p = 0.017), as was maximum intraoperative PaCO2 (72.2
± 15.6 vs. 48.3 ± 6.3 mmHg, p Conclusions: A thoracoscopic esophagectomy in the prone position performed concomitantly
with a CO2 pneumothorax procedure resulted in a significantly better
P/F ratio during one-lung ventilation as compared to the lateral position,
indicating that the prone position is more advantageous for oxygenation.