Evaluation of tissue oxygenation in general, spinal and epidural anesthesia applications in prone position

Aim: We aimed to evaluate the effect of General, Spinal and Epidural Anesthesia applications on tissue oxygenation by tissue oxygen saturation (StO2) in Lumbar Disc Herniation (LDH) surgery performed in the prone position. Materials and Methods: Volunteer patients between the ages of 18-65, ASA 1-3, who were operated electively by the Neurosurgery Clinic for LDH after the approval of the Recep Tayyip Erdoğan University Non-Interventional Clinical Research Ethics Committee with the date 14.07.2021 and the decision number 2021/129. was included in the study. Patients were divided into Group General Anesthesia (GA) , Spinal Anesthesia (SA) and Epidural Anesthesia (EA) with the Research Randomizer program. Demographic data, mean arterial pressure, heart rate, peripheral arterial oxygen saturation data, 0th, 10th minute StO2 and tissue hemoglobin index in supine position, 15th, 30th, 45th, 60th minute StO2 and tissue hemoglobin index in prone position data of 90 patients was saved. Results: The data of 90 patients were evaluated. Age, weight, height, ASA, amount of bleeding, duration of surgery and anesthesia were similar. GA's StO2 prone at 15., 30., 45., 60. XII min compared to other groups; EA was higher than SA at 45 min (p=0.001; p<0.05). When all groups were compared, the supine 0th min StO2 data were lower than the supine 10th min; however, supine 10th minute data were higher than prone 15th, 30th, 45th, 60th min (p=0.001; p<0.01). Prone StO2 was significantly higher at 15th minute compared to 45th, 60th and 30th min compared to 45th and 60th min (p=0.001; p<0.01). Conclusions: Tissue oxygenation gradually decreased in the prone position in all patients undergoing LDH surgery who underwent GA, SA, EA. Tissue oxygenation was better in the GA group than in regional anesthesia. When regional anesthesia methods were compared among themselves, tissue oxygenation of EA was higher. EA can be applied in patients who avoid GA due to comorbidities; however, we think that GA with better tissue oxygenation may be preferred in patients with peripheral circulation problems. Keywords: Prone Position, General Anesthesia, Spinal Anesthesia, Epidural Anesthesia, Tissue Oxygen Saturation, Microcirculation.