The effect of prone positioning with surgical bolsters on liver blood flow in healthy volunteers

• Published in: Anaesthesia Vol. 71; no. 5; pp. 550 - 555
• Main Authors: Chikhani, M., Evans, D. L., Blatcher, A. W., Jackson, A. P., Guha, I. N., Aithal, G. P., Moppett, I. K.
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01-05-2016
• Subjects: Anesthesia; Arginase - blood; Blood Pressure - physiology; Cardiac Output - physiology; cardiac output: factors affecting; Coloring Agents; Female; Healthy Volunteers; Heart; Heart Rate - physiology; hepatic blood flow: factors affecting; Humans; Indocyanine Green; Liver; Liver - enzymology; Liver Circulation - physiology; liver dysfunction; positioning: prone; Liver Function Tests; Male; Patient Positioning; Prone Position - physiology; Supine Position - physiology; Surgery; Young Adult; cardiac output: factors affecting; hepatic blood flow: factors affecting; liver dysfunction; positioning: prone
• ISSN: 0003-2409; 1365-2044
• DOI: 10.1111/anae.13416

Summary
This study sought to identify changes in hepatic flood flow and cardiac output during prone positioning on surgical bolsters in awake volunteers, and was prompted by a local incident of significant hepatic dysfunction following surgery in the prone position. Cardiac output was determined using the non‐invasive Peñáz technique, and plasma disappearance rate of indocyanine green (ICG‐PDR) was measured as a surrogate maker for hepatic blood flow along with serum hepatic enzyme assays. Measurements were made after one hour in supine, prone and returned supine positions. Ten volunteers completed the study. There were significant changes in the disappearance rate of indocyanine green, which decreased this from mean (SD) 31.1 (9.70) supine to 19.6 (4.37)%.min prone, respectively (p = 0.02), increasing on return to the supine position to 24.6 (5.54)%.min (p = 0.019). Cardiac output was also significantly reduced when changing from the supine to the prone position, from mean (SD) 4.7 (1.0 to 3.5 (1.1) (l.min−1), respectively (p = 0.002). We demonstrated an acute and reversible change in both hepatocellular function and cardiac output associated with the prone position.