A COMPARISON OF PHYSIOLOGICAL CHANGES INDUCED BY PRONE POSITION OVER WILSON’S FRAME AND HORIZONTAL BOLSTERS IN LUMBAR SPINE SURGERY – A RANDOMIZED PROSPECTIVE STUDY
Main Article Content
Keywords
Spine surgery, prone position, intra-abdominal pressure,Wilson’s frame, mean airway pressure, blood loss
Abstract
BACKGROUND: Ideal patient positioning involves balancing surgical comfort, against the risks related to the patient position. There is paucity of information on effect of prone position on blood loss and intra- abdominal pressure (IAP) and how these changes correlate with respiratory airway pressures. The study was designed to compare Wilson’s frame and horizontal bolsters to find a better technique for better intraoperative optimisation of the patient.
METHODS: The study was conducted on 60 patients after obtaining approval from ethical committee. Patients were positioned prone on Wilson’s frame (W) and Horizontal bolster (H). IAP was measured in the following positions and time intervals: IAP 1 (T1) - supine after the induction after placement of Foley’s catheter; IAP 2 (T2) - 10 minutes after correct positioning of the patient in prone position; and IAP 3 (T3) - at the end of surgery, before turning the patient supine. Simultaneously, airway pressures and vitals were recorded. Blood loss was estimated at the end of surgery.
RESULTS: Mean IAP was significantly higher in group W at T2 and T3 (p <0.001 each). Significantly higher airway pressuresobserved in Group W as compared to group H at T2 and T3. Blood loss in group W was significantly higher than average blood loss in group H (p = 0.006).
CONCLUSIONS: The patients who were positioned prone on horizontal bolsters for lumbar surgery had significantly lower IAP, airway pressures and lesser intraoperative blood loss as compared to patients positioned on Wilson’s frame.
METHODS: The study was conducted on 60 patients after obtaining approval from ethical committee. Patients were positioned prone on Wilson’s frame (W) and Horizontal bolster (H). IAP was measured in the following positions and time intervals: IAP 1 (T1) - supine after the induction after placement of Foley’s catheter; IAP 2 (T2) - 10 minutes after correct positioning of the patient in prone position; and IAP 3 (T3) - at the end of surgery, before turning the patient supine. Simultaneously, airway pressures and vitals were recorded. Blood loss was estimated at the end of surgery.
RESULTS: Mean IAP was significantly higher in group W at T2 and T3 (p <0.001 each). Significantly higher airway pressuresobserved in Group W as compared to group H at T2 and T3. Blood loss in group W was significantly higher than average blood loss in group H (p = 0.006).
CONCLUSIONS: The patients who were positioned prone on horizontal bolsters for lumbar surgery had significantly lower IAP, airway pressures and lesser intraoperative blood loss as compared to patients positioned on Wilson’s frame.
References
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13. Malhotra A, Gupta V, Abraham M, Punetha P, Bundela Y. Quantifying the amount of bleeding and associated changes in intra-abdominal pressure and mean airway pressure inpatients undergoing lumbar fixation surgeries: a comparison of three positioning systems. Asian Spine J 2016; 10(2): 199-204.
2. Kundra S, Bansal H, Gupta V, Gupta R, Kaushal S, Grewal A, et al. A comparative evaluation of the effect of prone positioning methods on blood loss and intra-abdominal pressure in obese patients undergoing spinal surgery. J Neuroanaesth Crit Care 2021;08(02): 92-8.
3. H. Edgcombe, K. Carter, S. Yarrow. Anaesthesia in the prone position. Br J Anaesth 2008;100(2): 165–83.
4. Kwee MM, Ho YH, Rozen WM. The prone position during surgery and its complications: a systematic review and evidence-based guidelines. Int surg 2015; 100(2): 292-303.
5. Kron IL, Harman PK, Nolan SP. The measurement of intra-abdominal pressure as a criterion for abdominal re-exploration. Ann surg 1984; 199(1): 28-30.
6. Kundra S, Gupta R, Luthra N, Dureja M, Katyal S. Effects of ventilation mode type on intra- abdominal pressure and intra-operative blood loss in patients undergoing lumbar spine surgery: A randomised clinical study. Indian J Anaesth 2021;65(Suppl 1):S12-S19.
7. Kim E, Kim HC, Lim YJ, Kim CH, Sohn S, Chung CK, et al. Comparison of intra-abdominal pressure among 3 prone positional apparatuses after changing from the supine to the prone position and applying positive end-expiratory pressure in healthy euvolemic patients: a prospective observational study. J Neurosurg Anesthesiol 2017; 29(1):14-20.
8. Manaa EM, Ibraheim OA, Smarkandi AH, Alotaibi WM, Elwatidy SM. The effect of prone position on respiratory mechanics during spinal surgery. Middle East J Anaesthesiol 2005; 18(3):623-30.
9. Kallet RH. A comprehensive review of prone position in ARDS. Respir Care 2015; 60(11): 1660-87.
10. Palmon SC, Kirsch JR, Depper JA, Toung TJ. The effect of the prone position on pulmonary mechanics is frame-dependent. Anesth Analg 1998; 87(5): 1175-80.
11. Manohar N, Ramesh VJ, Radhakrishnan M, Chakraborti D. Haemodynamic changes during prone positioning in anaesthetised chronic cervical myelopathy patients. Indian J Anaesth 2019;63(3):212-217.
12. Koh JC, Lee JS, Han DW, Choi S, Chang CH. Increase in airway pressure resulting from prone position patient placing may predict intraoperative surgical blood loss. Spine (Phila Pa 1976) 2013; 38(11): E678-82.
13. Malhotra A, Gupta V, Abraham M, Punetha P, Bundela Y. Quantifying the amount of bleeding and associated changes in intra-abdominal pressure and mean airway pressure inpatients undergoing lumbar fixation surgeries: a comparison of three positioning systems. Asian Spine J 2016; 10(2): 199-204.
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Published
Jul 01, 2025
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Dr. Shubham Khandelwal, Dr. Nisha Sharma, Dr. Vijay Mathur, Dr. Ravindra Sisodia, Dr. Avnish Bharadwaj, & Dr. Shubhina Gupta. (2025). A COMPARISON OF PHYSIOLOGICAL CHANGES INDUCED BY PRONE POSITION OVER WILSON’S FRAME AND HORIZONTAL BOLSTERS IN LUMBAR SPINE SURGERY – A RANDOMIZED PROSPECTIVE STUDY. Journal of Population Therapeutics and Clinical Pharmacology, 32(5), 1494-1502. https://doi.org/10.53555/bvxqdd14
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Author Biographies
Dr. Shubham Khandelwal
Assistant Professor, Department of Anaesthesiology and critical care
Dr. Nisha Sharma
Assistant Professor, Department of Neuro-anaesthesiology
Dr. Vijay Mathur
Professor and Head, Department of Neuro-anaesthesiology
Dr. Ravindra Sisodia
Assistant Professor and Director, Department of Neuro-anaesthesiology
Dr. Avnish Bharadwaj
Professor and Head, Department of Anaesthesiology and critical care Mahatma Gandhi Medical College and Hospital, Sitapura, Jaipur, Rajasthan.
Dr. Shubhina Gupta
Senior Resident and Fellow Department of GI and Liver transplant Medanta – The Medicity, Gurgaon, HaryanaHow to Cite
Dr. Shubham Khandelwal, Dr. Nisha Sharma, Dr. Vijay Mathur, Dr. Ravindra Sisodia, Dr. Avnish Bharadwaj, & Dr. Shubhina Gupta. (2025). A COMPARISON OF PHYSIOLOGICAL CHANGES INDUCED BY PRONE POSITION OVER WILSON’S FRAME AND HORIZONTAL BOLSTERS IN LUMBAR SPINE SURGERY – A RANDOMIZED PROSPECTIVE STUDY. Journal of Population Therapeutics and Clinical Pharmacology, 32(5), 1494-1502. https://doi.org/10.53555/bvxqdd14