PDF(Pubmed)
Abstract：
Prone positioning of patients is a routine occurrence in procedural suites and operating rooms (ORs). However, the physiological changes that occur with prone positioning are frequently underappreciated by proceduralists, surgeons, and anesthesiologists. This may be related to a sense of the routine or a lack of familiarity with physiological changes that accompany the prone position. The prone position, while aiding visualization and cannulation of the ampulla of Vater during endoscopic retrograde cholangiopancreatography (ERCP), can induce physiological changes such as reduced preload, inferior vena cava filling, and cardiac output; it can also increase intrathoracic pressure and mediastinal compression. Anesthetic agents can further impact cardiopulmonary physiology, decreasing systemic vascular resistance and reducing cardiac contractility. In addition, the transition from negative to positive pressure ventilation following endotracheal intubation can increase pulmonary artery pressures and right ventricular (RV) strain. Therefore, caution is needed with patients who have RV dysfunction, pulmonary hypertension, or preload dependency, as they may not tolerate prone positioning. We describe a case in which a 73-year-old male patient scheduled for an ERCP suffered cardiac arrest after being transitioned to the prone position. The patient was repositioned in the supine position and resuscitated. The case was completed in the supine position.
摘要：
患者的俯卧定位是手术间和手术室（ORs）中的常规情况。然而,俯卧位发生的生理变化经常被程序主义者低估，外科医生,还有麻醉师.这可能与常规感或缺乏对俯卧位伴随的生理变化的熟悉有关。俯卧位,在内镜逆行胰胆管造影术（ERCP）期间，Vater壶腹的可视化和插管，可以引起生理变化，如降低预紧力，下腔静脉充盈,和心输出量；它还可以增加胸内压和纵隔压缩。麻醉剂可以进一步影响心肺生理，降低全身血管阻力和降低心脏收缩力。此外,气管插管后从负压换气到正压换气可增加肺动脉压和右心室(RV)劳损.因此,有RV功能障碍的患者需要小心，肺动脉高压,或预加载依赖关系，因为他们可能不能容忍俯卧定位。我们描述了一个病例，其中一名计划接受ERCP的73岁男性患者在过渡到俯卧位后心脏骤停。患者以仰卧位重新定位并复苏。该病例以仰卧位完成。
