Exploring anesthesia-related complications in pediatric neurosurgery: a comparative analysis of the sitting and park-bench positions.

Background and aims: The purpose of this study is to analyze the sitting position and the park-bench position for intra-anesthesia complications in pediatric patients undergoing neurosurgery for posterior fossa lesions. Our goal is to highlight the risks associated with each of these positions under general anesthesia to aid in clinical decision making for optimal patient outcomes with regard to postoperative complications.

Methods: We retrospectively reviewed 41 pediatric patients (1 to 18 years old) undergoing posterior fossae surgery in the sitting (32) and park-bench (9) positions between January 2015 and December 2021. The majority of patients (15) who underwent surgery in the sitting position had fourth ventricular tumors (28.12%) and cerebellopontine tumors (18.76%) that required the sitting position.

Results: Of 32 patients operated on in the sitting position, 23 (71.78%) developed anesthetic complications, compared to 8 patients in the park-bench group (88.89%). Venous air embolism occurred in only 6.25% of patients in the sitting group. Compared to the sitting position, no cases of gas embolism were documented in the park-bench position. However, transient episodes of gas embolism cannot be excluded due to the higher incidence of hemodynamic instability (44.44%), need for additional fluid therapy (44.44%) and vasopressor support (11.11%), decreased CO2 (22.22%) and oxygen desaturation (22.22%). Patients who underwent surgery in the sitting position had a longer duration of surgery [247.5 min IQR (172.75 - 325.25)] and a longer duration of anesthesia [331 min IQR (237.5 - 423.25)]. Pneumocephalus (4, 12.5%) and postoperative hematoma (3, 9.38%) were the most common postoperative complications in patients who underwent surgery in the sitting position. In the park-bench group, three patients had postoperative complications, including postoperative hematoma (2, 25%) and hydrocephalus (1, 12.5%).

Conclusions: The incidence of anesthetic complications is lower in the sitting position compared to the park-bench position. Although there was no documented gas embolism in the park-bench position, the lower rate of venous air embolism in the sitting position may suggest a better control or a lower risk in this position. However, the sitting position has a less frequent occurrence of hemodynamic instability than the park-bench position.