Effect of head and body positioning on cerebral blood flow velocity in patients who underwent cranial surgery

Aim and objectives. The aim of this study was to investigate the effects of head and neck positions on the cerebral blood flow velocity by transcranial Doppler ultrasound in patients who underwent cranial surgery. Background. Inappropriate head elevation and body positioning in patients who undergo cranial surgery may affect cerebral blood flow and cerebral perfusion pressure. Designed. Experimental clinical study. Method. Our sample consisted of 38 patients who underwent cranial surgery between October 2009 and May 2010. The measurments of mean cerebral blood flow velocity were taken by the transcranial Doppler ultrasound through the temporal window. The mean cerebral blood flow velocity of the patients was measured in supine position with 0° and 30° head elevations, right and left lateral positions, right and left lateral positions with head flexion and extension. The measurements were taken before surgery and within 72 hours after surgery. Results. The mean cerebral blood flow velocity of the middle cerebral arteries was increased in head elevations from 0° to 30°, in right and lateral positions with 30° head elevations, but the velocity was decreased in head flexion and extension positions in preoperative and postoperative periods. Discussion. Head and body positioning, which is one of the nursing care activities, may affect intracranial pressure and cerebral perfusion pressure. Our results are similar with those of previous studies, which showed that head elevation did not affect the cerebral blood flow velocity. Relevance to clinical practice. By the results of this study, the head elevation of the patients, who underwent cranial surgery, should be 30° during the nursing care to provide optimum cerebral blood flow. Right and left lateral positioning is safe and recommended for these patients if there is no medical contraindication.