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Canadian Journal of Anesthesia 51:741-742 (2004)
© Canadian Anesthesiologists' Society, 2004

Correspondence

Peripheral oxygen saturation falls in the lateral lumbar puncture position

Kenzo Fujikura, MD, Taeko Fukuda, MD, Hajime Furukawa, MD and Hidenori Toyooka, MD

Ibaraki, Japan

To the Editor:

In the lateral lumbar puncture (LLP) position, patients are asked to bend forward as much as possible. This can restrict chest wall movement and provoke hypoxemia. However, little has been reported on the changes in partial pressure of arterial oxygen or peripheral oxygen saturation (SpO2) in the LLP position.1,2 We observed the changes in SpO2 using a pulse oximeter (N-395, Nellcor Puritan Bennett Inc., Pleasanton, CA, USA) during the time 60 patients (ASA physical status I–IV, 19–78 yr, 21 male and 39 female) assumed the LLP position. We also investigated whether the administration of oxygen (3 L•min–1) prevents SpO2 decrease.

Before the day of surgery, we measured the changes in SpO2 when the patients were in the sitting, supine and LLP positions in the ward. Patients were divided into two groups: a low group (lowest SpO2 less than 97%, n = 34) and a high group (lowest SpO2 equal to or more than 97%, n = 26). In the operating room, the low group patients received oxygen (3L·min–1) by nasal cannulae during spinal and/or epidural puncture.

The mean SpO2 for all patients in the sitting, supine and LLP positions were 98.7 ± 1.2, 98.2 ± 1.4, and 95.8 ± 2.4%, respectively. SpO2 in the LLP position was significantly lower than in the other two positions (P < 0.05; FigureGo). Body weight and body mass index (BMI) of the low group (59.8 ± 10.8 kg, 24.2 ± 4.2 kg•min–2) were significantly greater than those of the high group (52.7 ± 7.0 kg, 21.5 ± 2.3 kg•min–2; P < 0.05). There were weak negative correlations between the lowest SpO2 and body weight or BMI. Every patient whose BMI was more than 27 belonged to the low group. There was no significant difference between the low and high groups in age, gender, or ASA physical status. Oxygen administration increased SpO2 from 94.3 ± 1.9 to 97.1 ± 1.6 in the low group. No patient complained of discomfort or dyspnea during the two SpO2 measurements.



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  		FIGURE Preoperative assessment of peripheral oxygen saturation (SpO2) in the sitting, supine, and lateral lumbar puncture (LLP) positions. The X and Y axis of this scatter diagram are age and SpO2. *P < 0.05 vs sitting and supine positions.

 
The decrease in functional residual capacity as the subject changes from the seated to the supine position is more remarkable in obese than normal patients.3 Obesity is also considered an important risk factor for SpO2 decrease in the LLP position. It was concluded that the LLP position decreases SpO2 and that the administration of oxygen (3 L·;min–1) prevents it.

References

1 Kohro S, Yamakage M, Kawamata T, Iwasaki H, Namiki A. Effects of lumbar puncture position on arterial blood gases. J Anesth 1994; 8: 242–4.

2 Yun EM, Marx GF, Santos AC. The effects of maternal position during induction of combined spinal-epidural anesthesia for cesarean delivery. Anesth Analg 1998; 87: 614–8.[Abstract/Free Full Text]

3 Tucker DH, Sieker HO. The effect of change in body position on lung volumes and intrapulmonary gas mixing in patients with obesity, heart failure, and emphysema. Am Rev Respir Dis 1960; 82: 787–91.[Medline]





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