Effect of the prone position and head-down tilt on intra-abdominal pressure and on cerebral and splanchnic oxygenation in infants undergoing Posterior Sagittal AnoRectoPlasty for anorectal malformations.

Franzini, Stefania; Morandi, Anna; Consonni, Dario; Calderini, Edoardo; Leva, Ernesto

Posterior sagittal anorectoplasty (PSARP)(1) is the predominant surgical procedure for anorectal malformations. It's performed in the prone head-down tilt (HDT) position, providing excellent surgical exposure. This position may however affect ventilation (2), and increase intra-abdominal pressure (IAP), impairing tissue oxygenation and perfusion. Near-Infrared Spectroscopy (NIRS) is a non-invasive technique assessing regional tissue oximetry (3). This study aimed to evaluate, in infants undergoing PSARP, the effect of positioning (prone ± head-down tilt) on intra-abdominal pressure and on cerebral (CrSO2), renal (RrSO2) and mesenteric (MrSO2) regional oxygenation measured by NIRS.