Effect of patient positioning on anesthesiologic risk in endourological procedures

Theofanis Vrettos; Begona Ballesta Martinez; Arman Tsaturyan; Despoina Liourdi; Abdulrahman Al-Aown; Marco Lattarulo; Evangelos Liatsikos; Panagiotis Kallidonis

doi:10.4103/ua.ua_113_22

Effect of patient positioning on anesthesiologic risk in endourological procedures

Urol Ann. 2023 Jul-Sep;15(3):261-265. doi: 10.4103/ua.ua_113_22. Epub 2023 Jun 16.

Authors

Theofanis Vrettos¹, Begona Ballesta Martinez², Arman Tsaturyan², Despoina Liourdi³, Abdulrahman Al-Aown⁴, Marco Lattarulo², Evangelos Liatsikos^{2

5}, Panagiotis Kallidonis²

Affiliations

¹ Department of Anesthesiology and ICU, University of Patras, Patras, Greece.
² Department of Urology, University of Patras, Patras, Greece.
³ Department of Internal Medicine, General Hospital of Patras Ag. Andreas, Patras, Greece.
⁴ Department of Urology, Armed Forces Hospital Southern Region, Khamis Mushait, Saudi Arabia.
⁵ Medical University of Vienna, Austria.

Abstract

Objective: The objective is to compare supine and prone positions in terms of arterial blood gas during lithotripsy endourology procedures in different stages.

Material and methods: Cases of during lithotripsy endourology procedures in our department from March to September 2020 were included prospectively. The variables registered were body mass index, age, the American Society of Anesthesiologists (ASA) score, diabetes mellitus, positive end-expiratory pressure (PEEP), FiO₂, stone size, stone location, procedural type, position, procedure duration, PaO₂, SaO₂, PaCO₂, pH, and dynamic compliance. PaO₂, SaO₂, PaCO_2, pH, and dynamic compliance were recorded at the beginning of the procedure, 5 min later, 15 min later, and at the end of the procedure.

Results: Thirty patients in prone position and 30 in lithotomy position were included in this study. Patients in prone position underwent percutaneous nephrolithotomy, and patients in supine/lithotomy underwent retrograde intrarenal surgery or ureteroscopy. Statistically significant differences were found in PEEP, duration, PaO₂ at the beginning, SaO₂ at the beginning and at the end of the procedure, PaCO₂ at the beginning and at minute 5 and pH at the beginning of the surgery. The saturation PaO2 increased significantly on prone position and was statistically significantly better at the end of the surgery.

Conclusions: Both prone and supine positions were safe regarding anesthesiologic risk and had no clinically relevant differences in terms of individual comparisons in arterial blood gas parameters in static moments of the procedure. Prone position was related to an increase in PaO₂ and a drop in PaCO₂ gradually from the beginning to the end of the surgery.

Keywords: Anesthesia; endourology; patient positioning.