Truth or Myth: Intra-abdominal Pressure Increases in the Lithotomy Position

Karen Young; Tsung Mou; Julia Geynisman-Tan; Meera Tavathia; Sarah Collins; Margaret Mueller; Christina Lewicky-Gaupp; Kimberly Kenton

doi:10.1016/j.jmig.2020.03.005

Truth or Myth: Intra-abdominal Pressure Increases in the Lithotomy Position

Karen Young, Tsung Mou, Julia Geynisman-Tan^*, Meera Tavathia, Sarah Collins, Margaret Mueller, Christina Lewicky-Gaupp, Kimberly Kenton

^*Corresponding author for this work

Obstetrics and Gynecology

Research output: Contribution to journal › Article › peer-review

Abstract

Study Objective: To determine if there were differences in intra-abdominal pressure (IAP) in the supine, low lithotomy, and high lithotomy positions. Design: Prospective cohort study. Setting: University medical center. Patients: Twenty-nine women undergoing surgery for prolapse or stress incontinence. Interventions: Relevant medical history, including the pelvic organ prolapse quantification stage, body mass index, and airway grade (Mallampati score), was abstracted from patients’ medical charts. IAP was measured in centimeters of water (cmH₂O) on the day of their surgery before induction of general or intravenous anesthesia using a T-doc air charged urodynamic catheter (Laborie Aquarius; Ontario, Canada) placed in a patient's vagina (for patients with incontinence) or rectum (for patients with prolapse). Measurements and Main Results: IAP was measured in 3 positions: supine (legs at 0°), low lithotomy (legs in Yellowfin stirrups at 45°; Allen Medical, Acton, MA), and high lithotomy (legs at 90°). The means ± SDs IAP for the groups were as follows: in the supine position, 18.6 cmH₂O ± 7.6; low lithotomy, 17.7 cmH₂O ± 6.6; and high lithotomy, 17.1 cmH₂O ± 6.3. In the same women, there was a significant decrease in IAP from the supine to high lithotomy positions, with a mean difference of 1.4 cmH₂O ± 3.7, p =.05. Similarly, there was a significant, though smaller, decrease in mean IAP when moving from the supine to low lithotomy positions in these same women (mean decrease of 0.9 cmH₂O ± 1.5, p =.004). Neither change is clinically significant based on previous research that suggests 5 cmH₂O is a clinically significant change. Conclusion: Placing patients’ legs in a low or high lithotomy position does not result in a clinically significant increase in IAP. Therefore, surgeons and anesthesiologists can consider positioning patients’ lower extremities in stirrups while patients are awake to minimize discomfort and possibly reduce the risk of nerve injuries.

Original language	English (US)
Pages (from-to)	26-29
Number of pages	4
Journal	Journal of Minimally Invasive Gynecology
Volume	28
Issue number	1
DOIs	https://doi.org/10.1016/j.jmig.2020.03.005
State	Published - Jan 2021

Keywords

Intraabdominal pressure
Nerve injury
Patient safety

ASJC Scopus subject areas

Obstetrics and Gynecology

Access to Document

10.1016/j.jmig.2020.03.005

Fingerprint Dive into the research topics of 'Truth or Myth: Intra-abdominal Pressure Increases in the Lithotomy Position'. Together they form a unique fingerprint.

Cite this

@article{001dd825f36b433d8c909225c2d77a2c,

title = "Truth or Myth: Intra-abdominal Pressure Increases in the Lithotomy Position",

abstract = "Study Objective: To determine if there were differences in intra-abdominal pressure (IAP) in the supine, low lithotomy, and high lithotomy positions. Design: Prospective cohort study. Setting: University medical center. Patients: Twenty-nine women undergoing surgery for prolapse or stress incontinence. Interventions: Relevant medical history, including the pelvic organ prolapse quantification stage, body mass index, and airway grade (Mallampati score), was abstracted from patients{\textquoteright} medical charts. IAP was measured in centimeters of water (cmH2O) on the day of their surgery before induction of general or intravenous anesthesia using a T-doc air charged urodynamic catheter (Laborie Aquarius; Ontario, Canada) placed in a patient's vagina (for patients with incontinence) or rectum (for patients with prolapse). Measurements and Main Results: IAP was measured in 3 positions: supine (legs at 0°), low lithotomy (legs in Yellowfin stirrups at 45°; Allen Medical, Acton, MA), and high lithotomy (legs at 90°). The means ± SDs IAP for the groups were as follows: in the supine position, 18.6 cmH2O ± 7.6; low lithotomy, 17.7 cmH2O ± 6.6; and high lithotomy, 17.1 cmH2O ± 6.3. In the same women, there was a significant decrease in IAP from the supine to high lithotomy positions, with a mean difference of 1.4 cmH2O ± 3.7, p =.05. Similarly, there was a significant, though smaller, decrease in mean IAP when moving from the supine to low lithotomy positions in these same women (mean decrease of 0.9 cmH2O ± 1.5, p =.004). Neither change is clinically significant based on previous research that suggests 5 cmH2O is a clinically significant change. Conclusion: Placing patients{\textquoteright} legs in a low or high lithotomy position does not result in a clinically significant increase in IAP. Therefore, surgeons and anesthesiologists can consider positioning patients{\textquoteright} lower extremities in stirrups while patients are awake to minimize discomfort and possibly reduce the risk of nerve injuries.",

keywords = "Intraabdominal pressure, Nerve injury, Patient safety",

author = "Karen Young and Tsung Mou and Julia Geynisman-Tan and Meera Tavathia and Sarah Collins and Margaret Mueller and Christina Lewicky-Gaupp and Kimberly Kenton",

year = "2021",

month = jan,

doi = "10.1016/j.jmig.2020.03.005",

language = "English (US)",

volume = "28",

pages = "26--29",

journal = "Journal of Minimally Invasive Gynecology",

issn = "1553-4650",

publisher = "Elsevier",

number = "1",

}

Truth or Myth : Intra-abdominal Pressure Increases in the Lithotomy Position. / Young, Karen; Mou, Tsung; Geynisman-Tan, Julia; Tavathia, Meera; Collins, Sarah ; Mueller, Margaret ; Lewicky-Gaupp, Christina ; Kenton, Kimberly.

In: Journal of Minimally Invasive Gynecology, Vol. 28, No. 1, 01.2021, p. 26-29.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Truth or Myth

T2 - Intra-abdominal Pressure Increases in the Lithotomy Position

AU - Young, Karen

AU - Mou, Tsung

AU - Geynisman-Tan, Julia

AU - Tavathia, Meera

AU - Collins, Sarah

AU - Mueller, Margaret

AU - Lewicky-Gaupp, Christina

AU - Kenton, Kimberly

PY - 2021/1

Y1 - 2021/1

N2 - Study Objective: To determine if there were differences in intra-abdominal pressure (IAP) in the supine, low lithotomy, and high lithotomy positions. Design: Prospective cohort study. Setting: University medical center. Patients: Twenty-nine women undergoing surgery for prolapse or stress incontinence. Interventions: Relevant medical history, including the pelvic organ prolapse quantification stage, body mass index, and airway grade (Mallampati score), was abstracted from patients’ medical charts. IAP was measured in centimeters of water (cmH2O) on the day of their surgery before induction of general or intravenous anesthesia using a T-doc air charged urodynamic catheter (Laborie Aquarius; Ontario, Canada) placed in a patient's vagina (for patients with incontinence) or rectum (for patients with prolapse). Measurements and Main Results: IAP was measured in 3 positions: supine (legs at 0°), low lithotomy (legs in Yellowfin stirrups at 45°; Allen Medical, Acton, MA), and high lithotomy (legs at 90°). The means ± SDs IAP for the groups were as follows: in the supine position, 18.6 cmH2O ± 7.6; low lithotomy, 17.7 cmH2O ± 6.6; and high lithotomy, 17.1 cmH2O ± 6.3. In the same women, there was a significant decrease in IAP from the supine to high lithotomy positions, with a mean difference of 1.4 cmH2O ± 3.7, p =.05. Similarly, there was a significant, though smaller, decrease in mean IAP when moving from the supine to low lithotomy positions in these same women (mean decrease of 0.9 cmH2O ± 1.5, p =.004). Neither change is clinically significant based on previous research that suggests 5 cmH2O is a clinically significant change. Conclusion: Placing patients’ legs in a low or high lithotomy position does not result in a clinically significant increase in IAP. Therefore, surgeons and anesthesiologists can consider positioning patients’ lower extremities in stirrups while patients are awake to minimize discomfort and possibly reduce the risk of nerve injuries.

AB - Study Objective: To determine if there were differences in intra-abdominal pressure (IAP) in the supine, low lithotomy, and high lithotomy positions. Design: Prospective cohort study. Setting: University medical center. Patients: Twenty-nine women undergoing surgery for prolapse or stress incontinence. Interventions: Relevant medical history, including the pelvic organ prolapse quantification stage, body mass index, and airway grade (Mallampati score), was abstracted from patients’ medical charts. IAP was measured in centimeters of water (cmH2O) on the day of their surgery before induction of general or intravenous anesthesia using a T-doc air charged urodynamic catheter (Laborie Aquarius; Ontario, Canada) placed in a patient's vagina (for patients with incontinence) or rectum (for patients with prolapse). Measurements and Main Results: IAP was measured in 3 positions: supine (legs at 0°), low lithotomy (legs in Yellowfin stirrups at 45°; Allen Medical, Acton, MA), and high lithotomy (legs at 90°). The means ± SDs IAP for the groups were as follows: in the supine position, 18.6 cmH2O ± 7.6; low lithotomy, 17.7 cmH2O ± 6.6; and high lithotomy, 17.1 cmH2O ± 6.3. In the same women, there was a significant decrease in IAP from the supine to high lithotomy positions, with a mean difference of 1.4 cmH2O ± 3.7, p =.05. Similarly, there was a significant, though smaller, decrease in mean IAP when moving from the supine to low lithotomy positions in these same women (mean decrease of 0.9 cmH2O ± 1.5, p =.004). Neither change is clinically significant based on previous research that suggests 5 cmH2O is a clinically significant change. Conclusion: Placing patients’ legs in a low or high lithotomy position does not result in a clinically significant increase in IAP. Therefore, surgeons and anesthesiologists can consider positioning patients’ lower extremities in stirrups while patients are awake to minimize discomfort and possibly reduce the risk of nerve injuries.

KW - Intraabdominal pressure

KW - Nerve injury

KW - Patient safety

UR - http://www.scopus.com/inward/record.url?scp=85083671248&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85083671248&partnerID=8YFLogxK

U2 - 10.1016/j.jmig.2020.03.005

DO - 10.1016/j.jmig.2020.03.005

M3 - Article

C2 - 32229258

AN - SCOPUS:85083671248

VL - 28

SP - 26

EP - 29

JO - Journal of Minimally Invasive Gynecology

JF - Journal of Minimally Invasive Gynecology

SN - 1553-4650

IS - 1

ER -