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Impact of Trendelenburg (head down) and reverse Trendelenburg (head up) position on respiratory and cardiovascular function in anaesthetized horses

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Abstract
Objective: To describe the cardiorespiratory effects of a change in table position in anaesthetized horses. Study design: Prospective, crossover, randomized, experimental study. Animals: Six adult horses (mean body weight 621 +/- 59 kg, aged 13 +/- 4 years). Methods: The horses were anaesthetized twice in dorsal recumbency. They were either placed in the Trendelenburg position (head down; HD) followed by reverse Trendelenburg position (head up; HU) or in reverse order. Every position was maintained for 90 minutes. The order of positions was randomly assigned at initial anaesthesia. Extensive cardiorespiratory monitoring was performed. Statistical analysis consisted of a mixed model with horses as random effect and time, position, section of anaesthesia and interaction between those as fixed effects (p < 0.05). Results: When HU was applied during the first section of anaesthesia, PaO2, (p = 0.012), oxygen saturation (SaO(2), p < 0.01) and oxygen content (CaO2, p < 0.01) were significantly higher, while venous admixture (Qs/Qt, p < 0.01), mean arterial (p = 0.039), right atrial (p < 0.01) and mean pulmonary arterial pressure (p < 0.01) were lower than in HD. After changing from HU to HD, PaO2 and SaO(2) remained higher and Qs/Qt lower compared to the inverse order. Independent of the order, in the HD position Qs/Qt (p = 0.019) increased while PaO2 (p < 0.01), SaO(2) (p = 0.011), CaO2 (p < 0.01), venous PO2 (PvO(2); p = 0.019), venous saturation (p = 0.004) and venous oxygen content (p = 0.010) decreased over time. No significant differences were found for cardiac output, oxygen delivery, oxygen consumption and dobut-amine requirement between the two positions. Conclusions and clinical relevance: Gas exchange is better preserved in HU compared to HD, especially if applied from the start of the anaesthesia.
Keywords
anaesthesia, equine, hypoxaemia, reverse Trendelenburg, Trendelenburg, table position, MORBIDLY OBESE-PATIENTS, ARTERIAL OXYGEN-TENSION, BLOOD-GAS VALUES, BODY POSITION, VENTILATION, LUNG, ANESTHESIA, MECHANICS, PRESSURE, SURGERY

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Chicago
Binetti, Anna, Martina Mosing, Muriel Sacks, Luc Duchateau, Frank Gasthuys, and Stijn Schauvliege. 2018. “Impact of Trendelenburg (head down) and Reverse Trendelenburg (head up) Position on Respiratory and Cardiovascular Function in Anaesthetized Horses.” Veterinary Anaesthesia and Analgesia 45 (6): 760–771.
APA
Binetti, A., Mosing, M., Sacks, M., Duchateau, L., Gasthuys, F., & Schauvliege, S. (2018). Impact of Trendelenburg (head down) and reverse Trendelenburg (head up) position on respiratory and cardiovascular function in anaesthetized horses. VETERINARY ANAESTHESIA AND ANALGESIA, 45(6), 760–771.
Vancouver
1.
Binetti A, Mosing M, Sacks M, Duchateau L, Gasthuys F, Schauvliege S. Impact of Trendelenburg (head down) and reverse Trendelenburg (head up) position on respiratory and cardiovascular function in anaesthetized horses. VETERINARY ANAESTHESIA AND ANALGESIA. 2018;45(6):760–71.
MLA
Binetti, Anna, Martina Mosing, Muriel Sacks, et al. “Impact of Trendelenburg (head down) and Reverse Trendelenburg (head up) Position on Respiratory and Cardiovascular Function in Anaesthetized Horses.” VETERINARY ANAESTHESIA AND ANALGESIA 45.6 (2018): 760–771. Print.
@article{8582122,
  abstract     = {Objective: To describe the cardiorespiratory effects of a change in table position in anaesthetized horses. 
Study design: Prospective, crossover, randomized, experimental study. 
Animals: Six adult horses (mean body weight 621 +/- 59 kg, aged 13 +/- 4 years). 
Methods: The horses were anaesthetized twice in dorsal recumbency. They were either placed in the Trendelenburg position (head down; HD) followed by reverse Trendelenburg position (head up; HU) or in reverse order. Every position was maintained for 90 minutes. The order of positions was randomly assigned at initial anaesthesia. Extensive cardiorespiratory monitoring was performed. Statistical analysis consisted of a mixed model with horses as random effect and time, position, section of anaesthesia and interaction between those as fixed effects (p {\textlangle} 0.05). 
Results: When HU was applied during the first section of anaesthesia, PaO2, (p = 0.012), oxygen saturation (SaO(2), p {\textlangle} 0.01) and oxygen content (CaO2, p {\textlangle} 0.01) were significantly higher, while venous admixture (Qs/Qt, p {\textlangle} 0.01), mean arterial (p = 0.039), right atrial (p {\textlangle} 0.01) and mean pulmonary arterial pressure (p {\textlangle} 0.01) were lower than in HD. After changing from HU to HD, PaO2 and SaO(2) remained higher and Qs/Qt lower compared to the inverse order. Independent of the order, in the HD position Qs/Qt (p = 0.019) increased while PaO2 (p {\textlangle} 0.01), SaO(2) (p = 0.011), CaO2 (p {\textlangle} 0.01), venous PO2 (PvO(2); p = 0.019), venous saturation (p = 0.004) and venous oxygen content (p = 0.010) decreased over time. No significant differences were found for cardiac output, oxygen delivery, oxygen consumption and dobut-amine requirement between the two positions. 
Conclusions and clinical relevance: Gas exchange is better preserved in HU compared to HD, especially if applied from the start of the anaesthesia.},
  author       = {Binetti, Anna and Mosing, Martina and Sacks, Muriel and Duchateau, Luc and Gasthuys, Frank and Schauvliege, Stijn},
  issn         = {1467-2987},
  journal      = {VETERINARY ANAESTHESIA AND ANALGESIA},
  language     = {eng},
  number       = {6},
  pages        = {760--771},
  title        = {Impact of Trendelenburg (head down) and reverse Trendelenburg (head up) position on respiratory and cardiovascular function in anaesthetized horses},
  url          = {http://dx.doi.org/10.1016/j.vaa.2018.01.012},
  volume       = {45},
  year         = {2018},
}

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