Profound Intraoperative Metabolic Acidosis and Hypotension in a Child Undergoing Multilevel Spinal Fusion
The prone position may cause cardiovascular system depression. Yet, the mechanisms involved and preemptive measures are not well understood (Edgcombe et al. (2008)). During spinal surgery in the prone position, hypotension may occur. Implicated factors include prolonged abdominal compression impedi...
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| Format: | Article |
| Language: | English |
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Wiley
2009-01-01
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| Series: | Case Reports in Medicine |
| Online Access: | http://dx.doi.org/10.1155/2009/190263 |
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| author | Mohanad Shukry Jonathan A. D'Angelo Minal Joshi Jorge A. Cure Alberto J. de Armendi |
| author_facet | Mohanad Shukry Jonathan A. D'Angelo Minal Joshi Jorge A. Cure Alberto J. de Armendi |
| author_sort | Mohanad Shukry |
| collection | DOAJ |
| description | The prone position may cause cardiovascular system depression. Yet, the mechanisms involved and preemptive measures are not well understood (Edgcombe et al. (2008)). During spinal surgery in the prone position, hypotension may occur. Implicated factors include prolonged abdominal compression impeding venous return resulting in increased blood loss, decreased cardiovascular reserve, and the use of total intravenous anesthesia (TIVA) which has been shown to blunt the sympathetic response more than inhalation anesthesia. We present a case of hypotension during spinal surgery with all its challenges. Hypotension and acidosis persisted despite all supporting measures, and only to improve with supine positioning. Differential diagnosis for such an event are discussed. Although abdominal compression may not be obvious before the start of surgery, compressing the spine during surgery may lead to abdominal compression and hypoperfusion to abdominal organs. |
| format | Article |
| id | doaj-art-a5ffcd88668045c3b70b1c47805f898d |
| institution | DOAJ |
| issn | 1687-9627 1687-9635 |
| language | English |
| publishDate | 2009-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Medicine |
| spelling | doaj-art-a5ffcd88668045c3b70b1c47805f898d2025-08-20T03:20:00ZengWileyCase Reports in Medicine1687-96271687-96352009-01-01200910.1155/2009/190263190263Profound Intraoperative Metabolic Acidosis and Hypotension in a Child Undergoing Multilevel Spinal FusionMohanad Shukry0Jonathan A. D'Angelo1Minal Joshi2Jorge A. Cure3Alberto J. de Armendi4Department of Anesthesiology, The Children's Hospital, University of Oklahoma Health Sciences Center, 750 North East 13th Street, Suite 200, Oklahoma City, OK 73104, USADepartment of Anesthesiology, The Children's Hospital, University of Oklahoma Health Sciences Center, 750 North East 13th Street, Suite 200, Oklahoma City, OK 73104, USADepartment of Anesthesiology, The Children's Hospital, University of Oklahoma Health Sciences Center, 750 North East 13th Street, Suite 200, Oklahoma City, OK 73104, USADepartment of Anesthesiology, The Children's Hospital, University of Oklahoma Health Sciences Center, 750 North East 13th Street, Suite 200, Oklahoma City, OK 73104, USADepartment of Anesthesiology, The Children's Hospital, University of Oklahoma Health Sciences Center, 750 North East 13th Street, Suite 200, Oklahoma City, OK 73104, USAThe prone position may cause cardiovascular system depression. Yet, the mechanisms involved and preemptive measures are not well understood (Edgcombe et al. (2008)). During spinal surgery in the prone position, hypotension may occur. Implicated factors include prolonged abdominal compression impeding venous return resulting in increased blood loss, decreased cardiovascular reserve, and the use of total intravenous anesthesia (TIVA) which has been shown to blunt the sympathetic response more than inhalation anesthesia. We present a case of hypotension during spinal surgery with all its challenges. Hypotension and acidosis persisted despite all supporting measures, and only to improve with supine positioning. Differential diagnosis for such an event are discussed. Although abdominal compression may not be obvious before the start of surgery, compressing the spine during surgery may lead to abdominal compression and hypoperfusion to abdominal organs.http://dx.doi.org/10.1155/2009/190263 |
| spellingShingle | Mohanad Shukry Jonathan A. D'Angelo Minal Joshi Jorge A. Cure Alberto J. de Armendi Profound Intraoperative Metabolic Acidosis and Hypotension in a Child Undergoing Multilevel Spinal Fusion Case Reports in Medicine |
| title | Profound Intraoperative Metabolic Acidosis and Hypotension in a Child Undergoing Multilevel Spinal Fusion |
| title_full | Profound Intraoperative Metabolic Acidosis and Hypotension in a Child Undergoing Multilevel Spinal Fusion |
| title_fullStr | Profound Intraoperative Metabolic Acidosis and Hypotension in a Child Undergoing Multilevel Spinal Fusion |
| title_full_unstemmed | Profound Intraoperative Metabolic Acidosis and Hypotension in a Child Undergoing Multilevel Spinal Fusion |
| title_short | Profound Intraoperative Metabolic Acidosis and Hypotension in a Child Undergoing Multilevel Spinal Fusion |
| title_sort | profound intraoperative metabolic acidosis and hypotension in a child undergoing multilevel spinal fusion |
| url | http://dx.doi.org/10.1155/2009/190263 |
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