Korean J Anesthesiol.  2012 Apr;62(4):317-321. 10.4097/kjae.2012.62.4.317.

Hemodynamic effect of full flexion of the hips and knees in the supine position: a comparison with straight leg raising

• Kweon TD
• Jung CW
• Park JW
• Jeon YS
• Bahk JH

• KMID: 2238026
• DOI: http://doi.org/10.4097/kjae.2012.62.4.317

Abstract

BACKGROUND
Straight raising of the legs in the supine position or Trendelenburg positioning has been used to treat hypotension or shock, but the advantages of these positions are not clear and under debate. We performed a crossover study to evaluate the circulatory effect of full flexion of the hips and knees in the supine position (exaggerated lithotomy), and compare it with straight leg raising.
METHODS
This study was a prospective randomized crossover study from the tertiary care unit at our university hospital. Twenty-two patients scheduled for off-pump coronary artery bypass surgery were enrolled. Induction and maintenance of anesthesia were standardized. Exaggerated lithotomy position or straight leg raising were randomly selected in the supine position. Hemodynamic variables were measured in the following sequence: 10 min after induction, 1, 5, and 10 min following the designated position, and 1 and 5 min after returning to the supine position. Ten min later, the other position was applied to measure the same hemodynamic variables.
RESULTS
During the exaggerated lithotomy position, cerebral and coronary perfusion pressure increased significantly (P < 0.01) without a change in cardiac output. During straight leg raising, cardiac output increased at 5 min (P < 0.05) and cerebral and coronary perfusion pressures did not increase except for cerebral perfusion pressure at 1 min. However, the difference between the two groups at each time point in terms of cerebral perfusion pressure was clinically insignificant.
CONCLUSIONS
Full flexion of the hips and knees in the supine position did not increase cardiac output but may be more beneficial than straight leg raising in terms of coronary perfusion pressure.

Keyword

Hemodynamics; Positioning

MeSH Terms

Anesthesia
Cardiac Output
Coronary Artery Bypass, Off-Pump
Cross-Over Studies
Hemodynamics
Hip
Humans
Hypotension
Knee
Leg
Perfusion
Prospective Studies
Shock
Supine Position
Tertiary Healthcare