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Basic Principles of Anesthesia - CP > Positioning > Flashcards

Positioning Flashcards

1
Q

What standard is related to positioning?

A

Standard 8

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2
Q

Which are the most common areas for positioning injuries?

A

ulnar nerve and brachial plexus

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3
Q

What are the 7 goals for positioning?

A

patient safety, optimize surgical exposure, preserve patient dignity, maintain hemodynamic stability, maintain cardiorespiratory function, no ischemia, injury or compression, joint commission safety goal to prevent pressure ulcers

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4
Q

Cardiovascular concerns with anesthetics

A

volatile anesthetics decrease CO/BP, NMBs decrease muscle tone/venous return, opioids decrease HR/CO

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5
Q

Prone position barrier to thoracic excursion

A

reduced capacity for chest expansion

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6
Q

Mechanisms associated with nerve injury

A

compression, transection, stretch, traction

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7
Q

Direct nerve sheath ischemia cause

A

compression

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8
Q

Indirect nerve sheath ischemia cause

A

compartment syndrome

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9
Q

Risk factors for integumentary issues/pressure ulcer

A

elderly, diabetes, PVD, surgical time (>4 hr), chronic hypotension, body habitus

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10
Q

Different types of surgical positions

A

supine, prone, lithotomy, lateral, sitting, trendelenburg, reverse T-burg, high lithotomy, low lithotomy, jack knife

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11
Q

What are different pressure points when lying supine?

A

occiput, thoracic vertebrae, humerous, elbow, sacrum, thighs, heel, toes, scapulae, coccyx

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12
Q

Arm positioning considerations for supine position

A

arms placed laterally with palms against sides or abducted <90 degrees on armboards with padding and straps supinated forearms (palms up)

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13
Q

Why should the forearms be supinated while in supine position?

A

to avoid brachial plexus injury

if placed in pronation there can be ulnar nerve compression

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14
Q

Leg positioning considerations for supine position

A

legs flat and uncrossed, knees slightly flexed, padding on heels

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15
Q

Why should the knees be slightly flexed in supine position?

A

to avoid sciatic nerve stretch/injury

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16
Q

How does flexion and extension of the neck effect ETT position?

A

remember the hose follows the nose!

Flexion and extension move the tube 1.9 cm and rotation of the head results in the tube moving 0.6 cm

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17
Q

Cardiopulmonary implications of supine position

A

reduced TLC and FRC, diaphragm shifts cephalad, BP stability

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18
Q

Prone positioning considerations

A

intubated on stretcher before positioning onto OR table, keep head/neck neutral, arms < 90 degrees

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19
Q

What is the first thing you should do after any position change?

A

check the tube!

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20
Q

What types of surgical cases would we use the prone position?

A

spine, buttocks, rectum or peri-rectal, ankle, intracranial

21
Q

Prone cardiopulmonary considerations

A

pooling of blood in lower extremities and abdomen, compression of inferior vena cava, epidural engorgement, decreased compliance if chest not freely hanging, increased FRC

22
Q

Which body parts should we be mindful of with prone positioning?

A

genitalia (penis), breasts, lower legs, face, eyes, nose

23
Q

What causes an increased risk of postoperative vision loss?

A

prolonged surgical time, spine surgeries, prone position

24
Q

How can we prevent POVL

A

surgical duration <6hr, 10-15 degree head up (reduce orbital edema), BP 20% of preop baseline (MAP >70 mmHg), maintain Hct >25

25
Q

3 types of POVL

A

central retinal artery occlusion (CRAO), central retinal vein occlusion (CRVO), ischemic optic neuropathy (ION)

26
Q

What is the most common/prevalent POVL?

A

ischemic optic neuropathy

27
Q

What can be associated with ischemic optic neuropathy?

A

extended surgical time, extensive blood loss, obesity, male, wilson frame position

28
Q

What is NOT associated with ischemic optic neuropathy?

A

globe pressure

29
Q

Ocular perfusion pressure

A

= MAP - IOP

30
Q

Central retinal artery occlusion

A

“eye stroke”
sudden, profound vision loss, painless, monocular
caused from embolism, vasculitis, vasospasm, sickle cell, trauma, glaucoma

31
Q

Central retinal vein occlusion

A

“eye DVT”
variable - blurred vision to sudden vision loss, painless, monocular
risk factors include typical stroke risk factors, hypercoagulable states, glaucoma, compression of the vein in thyroid or orbital tumors

32
Q

how is a CRAO diagnosed vs CRVO

A

CRAO - retinal pallow, macular cherry red spot, +/- afferent pupillary defect
CRVO - optic disk edema, diffuse retinal hemorrhages, “blood and thunder”

33
Q

Lithotomy positioning considerations

A

legs abducted and elevated, fingers are free and should be protected (could be pinched in the footboard),

34
Q

What nerve injuries could be caused by lithotomy position?

A

peroneal - if legs are not free

sciatic/femoral - hip flexion

35
Q

What surgeries is lithotomy position used for?

A

perineal structures, gynecological, urology

36
Q

Cardiopulmonary considerations with lithotomy positioning

A

20% reduced FRC, reduced VC, increased/shifted central blood volume, autotransfusion of 250-300 mL/leg when raised

37
Q

positioning considerations with lateral position

A

head neutral and supported, shoulders, hips, head, and legs aligned, chest and hip supports, dependent arm on padded armboard perpendicular to torso <90 degrees, axillary roll under dependent side of thorax

38
Q

which surgeries is lateral positioning used for?

A

kidney, shoulder, orthopedic (THA, hip), thorax

39
Q

cardiopulmonary considerations with lateral positioning

A

kidney rest - great vessels compressed, decrease VR
possible V/Q mismatch
FRC increased in nondependent lung (top), decreased in dependent lung (bottom)
dependent lung at risk for atelectasis and fluid accumulation

40
Q

What surgeries is sitting position used for?

A

cervical spine, shoulder, posterior fossa, breast reconstruction

41
Q

sitting position considerations

A

HOB 30-90 degrees, head secured, pad heels with legs flexed, arms secured

42
Q

potential complications with sitting position

A

VAE, pneumocephalus, quadriplegia

43
Q

cardiopulmonary considerations with sitting position

A

reduced SV and CO, decreased MAP and CVP, lower extremity venous pooling, decreased cerebral perfusion, increased FRC and compliance

44
Q

conversion factor for drop in MAP

A

1 cm rise = 0.75 mmHg drop in MAP

45
Q

trendelenburg positioning considerations

A

head down, shoulder braces

46
Q

things to think about/be worried about with trendelenburg positioning

A

dependent edema, increased ICP, IOP, CVP, plexus stretch/compression

47
Q

reverse trendelenburg positioning considerations

A

bed flat, head up, increased pulmonary compliance and FRC, decreased IOP, ICP, CPP, BP

48
Q

what is the CRNAs role in terms of positioning

A

call turns/repositioning, ensure patient stability

Basic Principles of Anesthesia - CP (7 decks)

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