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

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.