Comparison of Clinical Problems in Thoracoscopic Esophagectomy between Prone Position with Pneumothorax Procedure and Lateral Position

Yoshihiro Kasagi, Ryu Okutani, Yukiko Komatsu, Yutaka Oda, Yoshito Yamashita

Department of Anesthesiology, Osaka City General Hospital and Children’s Hospital 2-13-22 Miyakojima-Hondori, Miyakojima- Ku, Osaka, Japan.
Department of Digestive Surgery, Osaka City General Hospital and Children’s Hospital 2-13-22 Miyakojima- Hondori, Miyakojima-Ku, Osaka, Japan.

DOI: 10.4236/ojanes.2013.33034                

Abstract

Study Objective: We compared the effects of intraoperative body position on blood gas and fluid balance in patients undergoing a thoracoscopic esophagectomy as well as during operation and postoperative laboratory data. Design: Prospective study. Setting: Operating room and intensive care unit. Patients: ASA physical status 1 and 2 patients (n = 26), scheduled for elective thoracoscopic esophagectomy and immediate reconstruction under general anesthesia with one-lung ventilation were enrolled. Interventions: Patients were assigned to either the lateral (n = 16) or prone (n = 10) position groups based on the planned intraoperative body position. A pneumothorax procedure was concomitantly performed only in the prone position group. Measurements: Fluid balance, PaO₂/FIO₂ ratio (P/F ratio), and maximum PaCO₂ during the operation and postoperative laboratory data were analyzed. Main Results: There were no significant differences between the groups for amount of blood loss, blood transfusion, fluid infusion, or urine output. The P/F ratio during one-lung ventilation was significantly higher in the prone than the lateral position group (379 ± 122 vs. 297 ± 67 mmHg, p = 0.017), as was maximum intraoperative PaCO₂ (72.2 ± 15.6 vs. 48.3 ± 6.3 mmHg, p < 0.001). Conclusions: A thoracoscopic esophagectomy in the prone position performed concomitantly with a CO₂ pneumothorax procedure resulted in a significantly better P/F ratio during one-lung ventilation as compared to the lateral position, indicating that the prone position is more advantageous for oxygenation.

Keywords

Thoracoscopic Esophagectomy; Prone Position; Lateral Position; CO2 Pneumothorax; Oxygenation

Conflicts of Interest

The authors declare no conflicts of interest.

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