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Arterial oxygenation changes in valvular heart disease patients with cardiomegaly in different recumbent positions

Published online by Cambridge University Press:  13 October 2005

G. D. Puri
Affiliation:
Post Graduate Institute of Medical Education and Research (PGIMER), Department of Anaesthesia and Intensive Care and Department of Cardiothoracic and Vascular Surgery, Chandigarh, India
A. Dutta
Affiliation:
Post Graduate Institute of Medical Education and Research (PGIMER), Department of Anaesthesia and Intensive Care and Department of Cardiothoracic and Vascular Surgery, Chandigarh, India
N. K. Chinnan
Affiliation:
Post Graduate Institute of Medical Education and Research (PGIMER), Department of Anaesthesia and Intensive Care and Department of Cardiothoracic and Vascular Surgery, Chandigarh, India
S. K. S. Thingnam
Affiliation:
Post Graduate Institute of Medical Education and Research (PGIMER), Department of Anaesthesia and Intensive Care and Department of Cardiothoracic and Vascular Surgery, Chandigarh, India
S. K. Sharma
Affiliation:
Punjab University, Department of Statistics, Chandigarh, India
P. Chari
Affiliation:
Post Graduate Institute of Medical Education and Research (PGIMER), Department of Anaesthesia and Intensive Care and Department of Cardiothoracic and Vascular Surgery, Chandigarh, India
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Summary

Background and objective: We studied the effect of different recumbent positions (supine, left and right lateral decubitus), on arterial oxygenation in 42 valvular heart disease patients planned for cardiac surgery. All patients had cardiomegaly (cardiothoracic ratio ≥0.5) in their chest X-rays. Their left ventricular end-diastolic diameter was also noted from the preoperative echocardiogram. Methods: Arterial blood gas analysis was performed in supine, left and right lateral positions after keeping the patient in a given position for 15 min. During this period all patients received 35% oxygen supplementation. Results: Arterial oxygen tension and haemoglobin saturation were significantly higher in the right lateral position (PaO2 = 120.6 ± 29.5 mmHg, SaO2 = 98.1 ± 1.4%) than in supine (PaO2 = 111.0 ± 30.6 mmHg, SaO2 = 97.6 ± 2.2%) and left lateral positions (PaO2 = 109.7 ± 32.0 mmHg, SaO2 = 97.6 ± 1.7%; mean ± SD; P < 0.01). There was no significant difference in arterial oxygenation between left lateral and supine positions (P > 0.05). The change in PaO2 and SaO2 with change of posture from left to right was significantly related to left ventricular end-diastolic diameter (r = 0.50 and r = 0.63, respectively; Pearson correlation). Repeated measures of analysis of variance with left ventricular end-diastolic diameter as a covariate showed a significant change in arterial PaO2 with posture (P = 0.011). Conclusion: Right lateral posture improves arterial oxygenation in the valvular heart disease patient with an enlarged left ventricle. In the preoperative period, these patients may benefit from a right lateral posture when lying in bed.

Type
Original Article
Copyright
© 2005 European Society of Anaesthesiology

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