OR positioning

Question 1

vulnerable area of the median nerve

Answer 1

antecubital fossa

25% of injuries were associated with traumatic insertion or infiltration of an intravenous line

Question 2

vulnerable area of the radial nerve

Answer 2

most superficial portion of the radial nerve is in the lower one third of the upper arm where the nerve goes across the spiral groove of the humerus.

Question 3

brachial plexus vulnerability

Answer 3

is very susceptible to injury from stretching and compression because of its superficial course in the axilla and proximity to the humeral head

Question 4

vulnerable area of the ulnar nerve

Answer 4

the postcondylar groove of the humerus near olecranon

Question 5

Most frequent nerve injury occurs to the?

Answer 5

ulnar nerve

ulnar neuropahty

Question 6

top 3 most frequent nerve injuries?

Answer 6

1. ulnar neuropathy
2. brachial plexus
3. Spinal cord & lumbosacral nerve roots

Question 7

position associated with complication: VAE

Answer 7

sitting position

Question 8

position associated with complication: Pneumocephalus

Answer 8

sitting position

Question 9

position associated with complication: laryngeal edema and optic neuropathy

Answer 9

robotic surgery / trendelenburg

Question 10

position associated with complication: Lower extremity compartment syndrome

Answer 10

Lithotomy position

Question 11

Pulm phys changes due to robotic surgery

Answer 11

• phys changes are due to laparoscopic insufflation as well as the steep Trendelenburg positioning.
• increased pressure from and contents causes FRC to decrease, increased Pplat and PIP (can rise by 50%)
• change in pulm compliance and decreased FRC, and increased minute ventilation due to Co2 insufflation

Question 12

ulnar neuropathy presents as

Answer 12

inability to abduct the fifth finger and decreased sensation to the fourth and fifth fingers giving the appearance of a “claw” hand

Question 13

radial nerve injury presents as

Answer 13

can cause wrist drop, the inability to abduct the thumb, and the inability to extend the fingers from the metacarpophalangeal joints

Question 14

position associated with complication: HBE

Answer 14

sitting position

an exaggerated decrease in HR or SBP that can rapidly progress to intraoperative asystole requiring CPR, or cerebral ischemic stroke

Question 15

Most common LE nerve injury?

Answer 15

common peroneal (fibular) nerve injury

is most at risk for injury as it wraps around the lateral head of the fibula

Question 16

peroneal (fibular) neuropathy presents as

Answer 16

footdrop, inversion of the foot, and sensory deficit.

Question 17

femoral neuropathy presents as

Answer 17

decreased flexion of the hip, decreased extension of the knee, or a loss of sensation over the superior aspect of the thigh and medial/anteromedial side of the leg

Question 18

obturator nerve injury presents as

Answer 18

inability to adduct the leg and decreased sensation over the medial thigh