Positioning Flashcards
Possible complications include
Peripheral nerve injuries
Hypotension
Ventilatory compromise
Optic neuropathy
Physical injuries associated with positioning: such as
skin damage, fractures and amputation.
Can contribute to post-op complications.
Obesity Diabetes Arthritis Peripheral vascular disease, Alcohol abuse pre-existing neurological conditions
Most common surgical positions
Supine Trendelenburg Prone Lateral Decubitus LITHOTOMY Sitting
This position produces minimal circulatory effects
The supine (lying down)
FRC with supine
decreased by about 800 ml
The decrease in FRC with supine position reflect
Cephalad displacement of the diaphragm compressing the lung bases
What conditions can further decrease the FRC
This is further exacerbated by an enlarged abdomen such as with obesity, pregnancy, or ascites.
The hips and knees in supine position
are often flexed slightly with a pillow under the knees,
Hips and knees flexed in supine Facilitating
venous drainage from the lower extremities and decreasing anterior abdominal wall tension.
Heels and occiput should be
padded
For pregnant patient remember
put a wedge under the right hip of the pregnant patient in the supine position
What does the LEFT LATERAL DISPLACEMENT do
Keeps the gravid uterus from causing too much pressure on the inferior vena cava that decreases venous return to the heart further resulting to decrease in cardiac output.
If the arms can be abducted on a padded board it
must be no more than
90 degrees
Take care that there is no pressure on the
ulnar nerve at the elbow in the condylar groove.
The arms are often secured in a “papoose”
manner with a draw sheet. This effectively limits
the
anesthetist’s access to the arms.
Supine summary
Equalization of pressures throughout the arterial system;
increased right-sided filling and cardiac output
decreased heart rate and peripheral vascular resistance (PVR).
Gravity and lungs
Increases perfusion of dependent (posterior) lung segments; abdominal viscera displace diaphragm cephalad.
SV favors
dependent lung segments,
CV favors
independent (anterior) segments.
FRC decreases and may
fall below CV in older patients.
________the patient in supine position with a
head-down tilt
Trendelenburg
Trendelenburg abdominal viscera action ? can accentuate HyPOTENSION
The abdominal viscera push on the diaphragm, compressing lung bases and heart (↓SV). this can accentuate HYPOTENSION
Cardiac output also decreases in this position d/t
stimulation of baroreceptors
Trendelenburg