[The sitting position in neurosurgical anaesthesia: a survey of French practice]

Abstract

Introduction: It remains a French and international controversy about the use of the sitting position in neurosurgery. The aim of this study was to evaluate the frequency of sitting position use, perioperative monitoring and procedures for air embolism detection and treatment.

Study design: National postal survey.

Patients and methods: The survey was sent in may 2000 to the anaesthesiologists in 53 french public neurosurgical centers. Responses were collected during 9 months.

Results: Among the 44 centers (83%), 33 (75%) used the sitting position. In 20 centers (61%) it was limited for the surgical procedures for which the surgeon was unable to operate in other position. Perioperative monitoring for air embolism was: capnography (100%), Swan-Ganz catheter (21%), precordial Doppler ultrasonography (15%) and transoesophageal echocardiography (6%). Only 12 centers (36%) used 2 or more techniques of detection for perioperative air embolism. In the 25 centers (76%) of those, which used the sitting position systematic pre-operative identification of patent foramen ovale by contrast echocardiography was performed. Prevention procedures of air embolism were: plasma volume expansion (94%), antigravity suit (61%), mechanical ventilation with positive end-expiratory pressure (42%), and abdominal compression (24%). No protocol of air embolism prophylaxis was used in 18 centers.

Conclusion: The survey concerned 83% of the centers. The number of centers using the sitting position was larger than in other countries like United Kingdom, Germany and Japan. Despite its lack of sensitivity capnography was universally practised. Preoperative contrast echocardiography for patent foramen ovale detection was not considered as necessary in all centers. Expert recommendations may be required.