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Anesthesia Concepts > Operative Positioning > Flashcards

Operative Positioning Flashcards

1
Q

Who is responsible for making sure no nerve or soft tissue injury and treating physiological changes in OR

A

Anesthetist

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2
Q

What is primary concern

A

Patient safety and comfort

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3
Q 
Documentation:
Describe baseline \_\_ \_\_ \_\_
Describe \_\_ \_\_ 
Use of \_\_\_, \_\_, \_\_ position 
\_\_ done and \_\_\_
A

Range of motion
Infra operative position
Padding, frame, body
Checks, frequency

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4
Q

OR table
Weight limit
Length

A

136 kg or 300 lbs

80.7 inches

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5
Q

During transfer what is anesthesia responsible for

A

Head, neck, ivs, monitors

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6
Q

Safety strap
What it doesn’t do
What it does do

A

Doesn’t hold pt on table

Reminds them if they wake up to stay on table or keeps extremities on table

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7
Q 
Most common positions 
Supine or \_\_ which can go to \_\_ or \_\_ \_\_
\_\_\_\_
Prone or \_\_\_ \_\_ position 
\_\_\_ \_\_\_ 
\_\_\_
A

Supine or dorsal decubitus: trendelenburg or reverse trendelenburg

Lithotomy

Ventral decubitis

Lateral decubitis

Sitting

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8
Q 
Supine 
\_\_ \_\_ operative position 
Position preferred by \_\_\_\_ 
Access to \_\_\_, \_\_ for \_\_ and \_\_
Less \_\_\_ changes than other positions
A

Most common
Anesthesia
Airway, arms for ivs and monitors
Physiologic

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9
Q 
Pillow under head in supine 
Allows proper \_\_\_ position 
Avoids \_\_\_ extension and \_\_ flexion of neck- avoids plexus stretch or vascular compromise 
Doughnut shaped pillow avoids \_\_\_\_ 
No pressure on \_\_\_
A

Sniffing
Dorsal, lateral
Alopecia
Eyes

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10
Q

Arm boards in supine
Arms abducted __ __ degrees
Hands __ with palm __ not __

A

Less than 90 degrees

Supination, up, pronated

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11
Q

Arms tucked in supine
__ __ under pt __ or __ not ___
___ padded with palm __

A

Draw sheet, hip or torso, mattress

Elbow, in

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12
Q

Supine

Feet: heels not __ __ bed, heels __, legs not __

A

Hanging over
Padded
Crossed

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13
Q 
Supine lumbar support
Slight \_\_\_ of hips and knees 
Pillow under \_\_\_
\_\_/\_\_ shouldn't be crossed
\_\_ and \_\_ are highest points of spine when supine
A

Flexion
Knees
Legs/feet
C5 and L3

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14
Q

Mechanisms of peripheral nerve injury

5

A 
Stretching 
Compression 
Kinking 
Ischemia 
Transection
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15
Q

Brachial plexus
Nerve travels a __ __ course through fixed points
The __ __ fascia
Runs through __, __, and __

A

Long superficial
Vertebral foramina
Clavicle, scapula, humerus

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16
Q

Brachial plexus

Positioning injury occurs with __ extension, head ___ to __, or sagging ___

Excessive ___ of arm greater than __ degrees

__ or __ __ falls off of table

A

Neck, turned to side, sideways

Abduction, 90

Arm or arm board

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17
Q

Brachial plexus injury

___ __ shoulders in __ or __ position

Extending arms overhead in __ position

Compression against __ in __ position

A

Depressed sagging, prone or sitting

Prone

Thorax, lateral

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18
Q

Brachial plexus injury

___ braces

__ __ in cardiac surgery

Deficit if injured

__ or __ arm

Lack of muscle control in __, __, __
Lack of sensation in __ or ___

A

Shoulder

Sternal retractors

Limp or paralyzed

Arm, hand, wrist

Arm or hand

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19
Q

Radial nerve injury

Due to __ __ of radial nerve on the __ aspect of the __ against: surgical __, __ screen, ___ arm board, repeat __ __

A

External compression
Lateral, humerus
Retractors, ether, mismatched, BP inflation

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20
Q

Radial nerve deficit

Loss of __ of forearm
Weakness of __
Loss of __ of hand, __ drop, __ affected
Loss of sensation in __ arm, __ forearm, and part of __

A

Extension

Supination

Extension, wrist, fingers

Lateral, posterior, hand

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21
Q

Most common post op peripheral nerve injury

A

Ulnar nerve

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22
Q

Ulnar nerve runs in groove between __ of ulna and __ __ of humerus

A

Olecranon, medial epi condyle

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23
Q

Ulnar nerve

Injury with compression of nerve between the olecranon of __ and medial epicondyle of __ (___ with arm __)

__ with severe elbow ___

A

Ulna, humerus
Entrapment, extension

Stretch, flexion

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24
Q

Ulnar nerve injury

__ over medial epicondyle with __ of hand causing stretching

Compression against ___

Misplaced __ __

A

Dislocation, pronation

Bed

BP cuff

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25
Q

Ulnar nerve injury

Inability to __ or __ 5th finger

Loss of __ strength, esp ulnar side

Loss of sensation of __ surface of hand, __ or __ fingers

Eventually leads to atrophy of __ muscle of hand: __ hand

A

Abduct or oppose

Grip

Palmar, 4th or 5th

Intrinsic, claw

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26
Q

Supine CV changes
Minimal effect on __ and __

Initially have increased __ __. Increased __, __ ___, __, and __. This activates baroreceptors which __ sympathetic outflow and increases __ impulses. Leads to decrease of __ and __ if not blunted by ___

A

Circulation and perfusion

Venous return. Preload, stroke volume, CO, BP
Decreases, PNS
HR and PVR, anesthetics

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27
Q

Supine CV changes

Have reduced __ __ due to venous pooling in lower extremities

Decreases __ and __
Increases __

A

Venous return
CO and BP
HR

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28
Q

Supine CV changes
-__ compression by masses, pregnancy, obese abdomen, or ascites __ decrease ___ __ to the __ __ and decrease __ __ even more

A 
IVC
May
Venous return 
Right heart 
Cardiac output
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29
Q

Supine ventilatory changes

__ __ __ decreases +/- ___ ml due to cephalad displacement of the __ and compression of lung bases

A

Functional residual capacity, 800

Diaphragm

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30
Q

Supine vent changes
Lung volumes reduced by __ __
-loss of chest wall muscle tone with muscle relaxants reduces __ to inherent elastic recoil
-overcome with __ __ __

A

Muscle relaxants
Opposition
PPV

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31
Q

Supine cerebral blood flow

  • __ change due to __ __
  • there for ICP ___
A

Minimal, tight auto regulation

Unchanged

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32
Q

Trendelenberg

  • used to treat __ by increasing __ __
  • improves __ __ during abdominal and laparoscopic cases
  • helps prevent __ __
  • facilitates __ during CVL placement
A

Hypotension, venous return
Surgical exposure
Air embolism
Cannulation

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33
Q

Trendelenburg
Extreme caution with __ __
Place __ from root of neck over the __ __

A

Shoulder braces

Laterally, acromioclavicular joint

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34
Q

Trendelenberg CV changes

  • counteracts hypotension __ __
  • increases venous return up to __ __ into central circulation
  • increases __ workload
A

Short term
1 L
Heart

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35
Q

Trendelenberg CV changes

  • causes ___ blood flow to lower extremities
  • may cause compression of __ by abdomen pushing __
  • __ __ congestion
  • ___ activated which leads to: peripheral __ and __, decreases __ __ and may make __ __ worse in the long run
A 
Reduced 
Heart, cephalad 
Pulmonary vascular 
Baroreceptors, vasodilation, bradycardia, cardiac output 
Shock syndrome
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36
Q

Trendelenberg vent changes

-decreased __ __ and ___, increased __ and __ __ __

A

Lung compliance, FRC

PIP and pulmonary vascular congestion

37
Q

Trendelenburg vent changes

  • with spontaneous vent work of breathing is __
  • VQ mismatch with __ exceeding __ in apex of lung
  • what can happen to ETT
  • risk of __
  • what can lead to airway obstruction
A 
Increased
Perfusion, ventilation 
Dislodged into right bronchus 
Aspiration 
Face and airway edema
38
Q

Trendelenburg CBF
How ICP affects CBF
What other pressure changes due to this position

A

Increased ICP decreases CBF

Intraocular pressure increases

39
Q

Reverse trendelenburg
Used for surgical exposure of what, 1 specific ex
Variations may be used for 3 other surgeries
Variation of which position in terms of physiologic changes

A

Upper abdomen
Lap cholecystectomy
Shoulder, neck, intracranial surgery
Sitting position

40
Q

Reverse trendelenburg
Caution with what
Excessive __ __ of feet can cause __ __ nerve injury which results in what

A

Plantar flexion
Anterior tibial
Foot drop

41
Q

Reverse trendelenburg cv changes

  • ___ venous return leads to __ preload, __ co (__-__%), and __ BP
  • compensatory __ SNS tone, __, and __ by +/- __% which may be blunted by __
A

Decreased, decreased, decreased, 20-40, decreased

Increased, SVR, HR, 30, anesthetics

42
Q

Reverse trendelenburg vent changes

  • abdomen __ __ impede diaphragmatic excursion, FRC __
  • Ventilation is __
A

Does not
Increases
Easier

43
Q

Reverse trendelenburg CBF

  • CBF __ proportional to the degree of the __ __ (can be up to __%)
  • __ decreases
A

Decreases, head tilt up, 20

ICP

44
Q

Lithotomy position

  • hips flexed __-__ degrees
  • legs abducted __-__ degrees from midline
  • Lower legs __ to torso
  • watch __, __, and __ __ nerves
A

80-100

30-45

Parallel, femoral, sciatic, lower leg

45
Q

Lithotomy candy cane stirrups

  • __ __ flexion of the knees and or hips
  • common injury to __ __ nerve most, then __ and __
A

More acute

Common peroneal, sciatic, femoral

46
Q

Lithotomy knee crutch
Watch __ nerve 1st
Then also __ nerve and __ __ nerve

A

Popliteal

Tibial and common peroneal

47
Q

Lithotomy
Used for __, __, and __ procedures
Both legs positioned together to prevent __ of __ spine and hip flexion beyond __ degrees
Improper positioning can lead to nerve injuries in 6

A

Gyn, gu, rectal
Torsion, lumbar, 110
Femoral, sciatic, obturator, lateral femoral cutaneous, saphenous, common peroneal

48
Q

Most common damaged nerve of lower extremity

A

Common peroneal nerve

49
Q

Common peroneal nerve injury
Branch of __
Injury from __ of lateral aspect of knee in __ or __ position
Symptoms: __ __ and inability to __ foot, loss of ability to __ __ toes

A

Sciatic
Compression, stirrup, lateral
Foot drop, evert, dorsally extend

50
Q

Sciatic nerve injury
From excessive __ __ of __
Pressure in __ notch from __
Weakness or paralysis of muscles __ knee, __ foot, and __ half of calf.foot __

A

External rotation, hip
Sciatic, stretching
Below, numbness, lateral
Foot

51
Q

Femoral nerve injury
From __ at __ brim by __
Or excessive __ of thigh or __ of thighs and __ __ of hips

A

Compression, pelvic, retractor

Angulation, abduction, external rotation

52
Q

Femoral nerve injury

Results in loss of __ of hip and loss of __ of knee

Decreased sensation over __ aspect of __

A

Flexion, extension

Superior, thigh

53
Q

Saphenous nerve injury
Occurs when __ aspect of lower leg is __ against support bar

Results in __ in __ and __ side of calf

A

Medial, compressed

Parenthesis, medial, antermedial

54
Q

Lower extremity compartment syndrome

  • occurs when __ to an extremity is inadequate, resulting in __, __, and extensive __ from increased __ pressure
  • occurs with long surgical cases >__-__ hours
  • occurs with __ and __ __ positions
A

Perfusion, ischemia, edema, rhabdomyolysis
Tissue
2-3
Lithotomy and lateral decubitus

55
Q

Lithotomy CV changes

-__ venous return, __ preload to heart with __ increase in __ and increase in __

A

Increased, increased, transient, CO, BP

56
Q

Lithotomy CV changes

  • perfusion to __ __ reduced
  • perfusion pressure changes __ mmHg for each __ cm that a given point varies in vertical height above or below __
A

Lower extremities

2, 2.5, heart

57
Q

Lithotomy vent changes
Depending on degree of __ __ abdominal contents may push on diaphragm and impede __ with a decrease of lung __ and decrease __ and __ __

A

Hip flexion, excursion

Compliance, TV, vital capacity

58
Q

___ risk increases in lithotomy

A

Aspiration

59
Q

Lithotomy cerebral changes

__ __ in cerebral venous blood flow and increase in __ __ with legs elevated

A

Transient increase, ICP

60
Q

__ head tongs
Watch for bolt __
Want natural __ alignment
__, __, and __ free from pressure or metal parts touching

A

Mayfield
Slippage
Neck
Eyes, nose, chin

61
Q

Prone position
Do what first
Check __ and __ working
__ and __ supported to allow for free __ __ movement and increased __ __

A

Check lung sounds
IV, a line
Chest and hips, abdomen diaphragmatic
Neck alignment

62
Q

Head prone position
Head can be turned to side if adequate ___
Caution of obstruction of __ __ drainage and __ __ flow
__, __, and __ free of pressure

A

Mobility
Jugular venous, vertebral artery
Eyes, nose, ears

63
Q

Prone position eye injury
Direct __, __ eye, __
Treatment is __ __ and eye patch

A

Trauma, dry, swelling

Antibiotic ointment

64
Q

Prone position
Blindness caused by __ __ __ via __ __ or __ obstruction
By sustained direct pressure on eye/__
Leads to visual __, __ or __ blindness

A

Ischemic optic neuropathy, central vein or artery
Retina
Changes, partial, complete

65
Q

Risk factors for ischemic optic neuropathy: __ position, operative __, large operative __ __, large __ use

Pt specific risk factors: 6

Inc risk in __ and __ surgery

A

Prone, hypotension, blood loss, crystalloid

Anemia, smoker, diabetes, male, vascular pathology

Spinal and cardiac

66
Q

Prone position extremities

Where arms are, abducted how many degrees, extra padding where, prevent shoulders from what

A

On boards by head, less than 90, at elbow, sagging

67
Q

Prone position extremities

Watch for __ __ syndrome. If present do what to arms

Legs: __ __ and wear what

A

Thoracic outlet, arms tucked at sides

Slightly flexed, SCDs or TED hose

68
Q

Prone position CV changes
__ and __ compression lead to __
__ __ in lower legs leads to ___
In effect these decrease 3

A

IVC and aortic, hypotension
Venous pooling, hypotension
Preload, CO, BP

69
Q

Prone position vent changes

  • posterior ventilation __ perfusion
  • anterior perfusion __ ventilation
  • lung compliance __. __ __ pressures increase. __ of __ increases
  • use of what frees chest excursion, and __ __ __ overcomes compression
A
  • greater than
  • greater than
  • decreases. Peak airway. Work of breathing.
  • Rolls or bolsters, positive pressure ventilation
70
Q

Prone position and CBF
-turning head obstructs __ __ leading to __ __ volume and __

Excess flexion or turning obstructs __ __ flow

__ __ injury from stretch

A

Venous drainage, increased cerebral, ICP

Vertebral artery

Spinal cord

71
Q

Lateral decubitis position
Used for 4 surgeries
__ support to prevent brachial plexus injury
Limit pressure on dependent __ and __
__ roll placed __ to and __ of __ axillary

A

Shoulder, hip, kidney, thoracotomy
Head
Eye and ear
Axillary, caudad, outside of lower

72
Q

Lateral position
Arms: dependent vs non dependent

Legs: padding between legs and flexed __ leg to prevent which nerve injury. Padding on bed to prevent which nerve injury

A

Dependent arm on padded arm board perpendicular to torso
Non dependent arm supported over folded bedding or suspended w arm rest

Dependent, saphenous nerve. Common peroneal.

73
Q

Lateral position

__/__ support __ __ or __ posts

Safety strap between __ of __ and __ __

A

Anterior posterior
Bean bag or hip

Head of femur and iliac crest

74
Q

Lateral position cv changes
___ change
__ change in CO unless venous return obstructed by __ resting on vena cava

NIBP __ in __ arm

A

Minimal
No, kidney

Higher in dependent

75
Q

Lateral position vent changes

Awake and spontaneous breathing: lower lung is __ perfused and __ ventilated, but __, __, and __ increase/decrease

A

Better, better, FRC/Vc/tv decrease

76
Q

Lateral position vent changes
Anesthetized but spontaneous breathing
-__ lung better ventilated and __ long is better perfumed
Anesthetized and ventilated
-non dependent lung is __ and dependent lung is __ (__ VQ mismatch)

A

Non dependent, dependent

Over ventilated, over perfused, worse

77
Q

Lateral position CBF

__ change unless there is extreme __ of head

A

Minimal, flexion

78
Q

Sitting position
Used for 3 types of surgery

Facilitates __ drainage

A

Cranial, shoulder, numeral

Venous

79
Q

Sitting position
Head fixed in __ or __
Avoid excessive __ __ which obstructs venous outflow causing __ -or __ __ of brain, stretches __ nerve roots, can obstruct __, and can cause pressure on __

A

Pins or tape
Flexion, hypo perfusion, venous congestion, cervical
ETT, tongue

80
Q

Sitting position
Want at least __ __ between mandible and sternum

Avoid rigid __ __ which can lead to __ ischemia

A

2 finger breadths

Bite block, tongue

81
Q

Sitting position
Arms: prevent pressure on __ and __ them to prevent pulling on shoulder
Buttocks: positioned in __ of table
__ knees and hips to decrease stretch of __ nerve

A

Frame, support
Crease
Flex, sciatic

82
Q

Sitting position CV changes
-pooling of blood decreases __, __, and __
____**
-__ and __ increase to compensate but blunted by anesthetics
-treatment 5

A

Co, BP, preload
Hypotension
HR and SVR
Ivf, pressers, adjust anesthetic depth, stockings, active leg compression

83
Q

Sitting position vent changes
Lung __ and __ increase
______ easier

A

Volume and capacity

WOB

84
Q

Sitting CBF
CBF __
ICP __
Positioning can impede flow and cause __ or __ __ of brain

A

Decreased
Decreased
Hypo perfusion or congestion

85
Q

Sitting venous air embolism

  • risk __ __ during procedure when the __ __ is above the level of heart
  • inability of __ sinuses to __
A

Venous air embolism, surgical site

Venous, collapse

86
Q

Sitting air embolism

Signs: change in __ tones (__ __ murmur) heard via __ placed at ___ border which is __-__ IC space, __ murmur, __, __, __, decreased __, ___ in exhaled gas, circulatory compromise, __ __

A

Heart, wind mill, Doppler
Parasternal, 2-6th, new, dysrhythmias, hypotension, desat, etco2
Nitrogen, cardiac arrest

87
Q

Sitting air embolism detected with __ or __ __ ultrasound

A

TEE or precordial Doppler

88
Q 
Venous air embolism treatment 
\_\_\_ surgical field with \_\_
Apply \_\_ to cut bony edges 
Discontinue \_\_ \_\_ 
Close any open \_\_
Place on \_\_ o2, \_\_\_
\_\_\_ position 
Aspirate air from \_\_ \_\_ via a \_\_
A 
Flood, NS, Wax 
Nitrous oxide 
Vessels 
100%, peep 
Trendelenburg 
Right atrium, central catheter

Anesthesia Concepts (12 decks)

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