The impact of patient position changes on advanced hemodynamic indices in laparoscopic and open major abdominal cancer surgeries: retrospective study.

backgroundsPatient positioning (Trendelenburg vs. supine) may alter hemodynamics. This study aimed to compare the effects of position changes on cardiac parameters and vital signs in patients undergoing major abdominal cancer surgery, performed either laparoscopically or via open techniques, using esophageal Doppler monitoring (ODM) for intraoperative fluid management.

methodsAfter obtaining ethics committee approval, 80 patients who underwent major abdominal cancer surgery between November 2021 and November 2022 using ODM were retrospectively identified from the records of the Anesthesiology Clinic. These patients were analyzed based on whether they underwent open or laparoscopic procedures. Demographic information, vital signs, amount of blood loss, type and volume of administered fluids, as well as cardiac parameter measurements obtained with the ODM device in both the supine and Trendelenburg positions (> 45°), were examined. The ODM device recorded the following parameters: cardiac output (CO), flow time corrected (FTc), peak velocity (PV), and stroke distance (SD). The study aimed to determine whether there were significant variations in these parameters between the open and laparoscopic surgical approaches.

resultsThe demographic characteristics of the patients were similar in both the supine and Trendelenburg positions. The mean duration of surgery was 163 ± 30 min in the open surgery group and 153 ± 29 min in the laparoscopic surgery group (p = 0.137). The average amount of blood loss was 495 ± 280 ml in the open surgery group and 310 ± 240 ml in the laparoscopic group (p = 0.034). There was no significant difference in net fluid balance between the two groups (open surgery: 388 ± 60 ml; laparoscopic surgery: 473 ± 21 ml; p = 0.107). Continuous fluid monitoring revealed no changes in cardiac parameters during position changes in either group. However, an increase in mean arterial pressure was observed in the Trendelenburg position, regardless of the type of surgery (p = 0.003, p = 0.014, p < 0.05).

conclusionThe findings of this study are consistent with the existing literature, indicating that patient positioning did not alter cardiac parameters. We conclude that preservation of intravascular volume may reduce changes in cardiac parameters that could be caused by the Trendelenburg position or pneumoperitoneum. Continuous non-invasive hemodynamic monitoring may help ensure that positional changes do not adversely affect cardiac parameters.

trial registrationNCT06293391 and registration on 06 November 2024.