J Korean Neurosurg Soc.  2012 Feb;51(2):81-85. 10.3340/jkns.2012.51.2.81.

The Effect of Body Mass Index on Intra-Abdominal Pressure and Blood Loss in Lumbar Spine Surgery

• Han IH
• Son DW
• Nam KH
• Choi BK
• Song GS

• KMID: 1441414
• DOI: http://doi.org/10.3340/jkns.2012.51.2.81

Abstract

OBJECTIVE
The purpose of this prospective study was to evaluate the effects of body mass index (BMI) on intra-abdominal pressure (IAP) and intraoperative blood loss (IBL) during lumbar spinal surgery.
METHODS
Thirty patients scheduled for single level posterior lumbar interbody fusion were allocated equally to a normal group (Group 1, BMI;18.5-22.9 kg/m2), an overweight group (Group 2, BMI; 23-24.9 kg/m2), and an obese group (Group 3, BMI; 25.0-29.9 kg/m2) according to BMI. IAP was measured using a urinary bladder catheter; 1) supine after anesthesia induction, 2) prone at skin incision, 3) prone at the end of surgery. In addition, IBL was also measured in the three groups.
RESULTS
IAP in the supine position was not significantly different in groups 1, 2, and 3 (2.7 mm Hg, 3.0 mm Hg, and 4.2 mm Hg, respectively) (p=0.258), and IAP in the prone position at incision increased to 7.8 mm Hg, 8.2 mm Hg, and 10.4 mm Hg, respectively, in the three groups, and these intergroup differences were significant, especially for Group 3 (p=0.000). IAP at the end of surgery was slightly lower (7.0 mm Hg, 7.7 mm Hg, and 9.2 mm Hg, respectively). IBLs were not significantly different between the three groups. However, IBLs were found to increase with IAP in the prone position (p=0.022) and BMI (p<0.05).
CONCLUSION
These results show that BMI affects IAP in the prone position more than in the supine position during lumbar spinal surgery. In addition, IBLs were found to increase with IAP in the prone position and with BMI. Thus, IBLs can be expected to be higher in morbidly obese patients due to an increased IAP.

Keyword

Body mass index; Intra-abdominal pressure; Urinary bladder pressure; Intraoperative blood loss; Posterior lumbar interbody fusion

MeSH Terms

Anesthesia
Body Mass Index
Humans
Overweight
Prone Position
Prospective Studies
Skin
Spine
Supine Position
Urinary Bladder

Figure

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  Fig. 1 Intraoperative measuring of intra-abdominal pressure through urinary bladder catheter.

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  Fig. 2 Correlation of intraoperative blood loss (IBL) with body mass index (BMI). There was a significant correlation (p=0.022).

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  Fig. 3 Correlation of intraoperative blood loss (IBL) with intra-abdominal pressure in supine (IAP-S) (A), IAP in prone at the incision (IAP-PI) (B), and IAP in prone at the end of surgery (IAP-PE) (C). There was no correlation between IBL and IAP-S (p=0.092), but there was significant correlation between IBL and IAP in prone (p<0.05).

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