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AS - N928 Basic Principles of Anesthesia > Positioning > Flashcards

Positioning Flashcards

1
Q

AANA Standard 8

A

Positioning

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2
Q

Most Common Nerve Injuries

A

Ulnar nerve

Brachial plexus

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3
Q

Nerve Injury Mechanisms

A

Compression, transection, stretch, traction

Direct or indirect nerve sheath ischemia

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4
Q

Integumentary RISK

A 
Elderly
Diabetes
PVD
Surgical time
Chronic hypertension
Obesity
↑temperature
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5
Q

Supine Pressure Points

A 
Occiput (head)
Scapula (shoulders)
Vertebrae (spine)
Olecranon (elbow)
Sacrum
Coccyx
Calves
Calcaneum (heels)
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6
Q

Supine

A 
Arms lateral or abducted <90°
- Avoid brachial plexus stretch
- Palms facing towards thighs/trunk
Supinated forearm 
- Pronation → ulnar nerve compression
Legs flat & uncrossed
Consider lumbar support
Pad heels & elbows (ulnar nerve)
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7
Q

Supine Respiratory

A

↓TLC & FRC

Diaphragm shifts cephalad

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8
Q

Prone

A

Ventral decubitus
Often intubated
Arms <90°
Spine, buttocks, rectum or peri-rectal, ankle, intracranial surgeries

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9
Q

Prone CV

A

Blood pooling in abdomen & LE
Inferior vena cava compression
Epidural engorgement

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10
Q

Prone Respiratory

A

↓compliance (chest not freely hanging)

↑FRC d/t improved posterior lung ventilation

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11
Q

POVL

A 
Postop vision loss
Prolonged surgical time spine surgeries (prone)
CRAO - central retinal artery occlusion
CRVO - central retinal vein occlusion
ION - ischemic optic neuropathy
Cortical blindness
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12
Q

Most Common POVL

A

Ischemic optic neuropathy ION

  • Extended surgical time
  • Blood loss
  • Obesity
  • Male
  • Wilson frame
  • Ocular perfusion pressure OPP = MAP - IOP
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13
Q

POVL Prevention

A

Surgical duration <6hr
10-15° HOB elevation to reduce orbital edema
Maintain BP w/in 20% baseline
Hct >25

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14
Q

CRAO

A

Eye stroke
Sudden, profound vision loss
Painless blindness
Cherry red macula

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15
Q

CRVO

A

Eye DVT
Variable blurred vision to sudden vision loss
Optic disk edema
Diffuse retinal hemorrhages
- Hyper coagulable states
- Glaucoma
- Thyroid vein compression or orbital tumors

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16
Q

Lithotomy

A

Legs abducted & elevated
- Raise & lower legs together to prevent hip injury
Ensure fingers free from footboard
Peroneal nerve injury risk
Hip flexion → sciatic stretch or femoral nerve palsy
Perineal, gynecological, & urology surgeries

17
Q

Lithotomy CV

A

↑blood volume d/t shift

Autotransfusion 250-300mL/leg

18
Q

Lithotomy Respiratory

A

↓FRC 20%
↓VC
Hypoventilation when breathing spontaneously

19
Q

Lateral

A

Head neutral & supported
Shoulders, head, hips, & legs aligned
Ensure eyes, ears, & face are pressure free
Dependent arm on padded board or perpendicular to torso <90°
Axillary roll under dependent side
Shoulder, orthopedic (hip), thorax, & kidney surgeries

20
Q

Lateral CV

A

Minimal changes

Kidney rest - vessels compressed ↓VR

21
Q

Lateral Respiratory

A

V/Q mismatch
↑FRC non-dependent lung
↓FRC dependent lung
Dependent lung prone to atelectasis & fluid accumulation

22
Q

Sitting

A

HOB 30-90°
Ensure at least 2 fingerbreadths b/w neck & mandible
Pad heels & flex legs to prevent sciatic stretch
Arms secured to padded arm boards or lay across patient lap w/ draw sheet
Cervical spine, shoulder, posterior fossa, & breast reconstruction surgeries

23
Q

Sitting CV

A

↓SV/CO up to 20%
↓MAP/CVP
Lower extremity venous pooling
↓cerebral perfusion CPP = MAP - ICP

24
Q

Sitting Respiratory

A

↑FRC

↑compliance

25
Q

Sitting Complications

A

VAE - venous air embolus d/t negative pressure gradient

Pneumocephalus often benign
- Air enters open dura, CSF drainage, surgical decompression

Quadriplegia d/t spinal cord stretch when head flex & loss autoregulation w/ general anesthesia
- Ensure 2 fingerbreadths to prevent strain at C5

26
Q

Trendelenburg

A

Dependent edema
↑ICP/IOP
↑CVP
Shoulder braces → brachial plexus stretch or compression

27
Q

Reverse Trendelenburg

A 
Bed flat w/ head up
↓ICP/IOP
↓CPP/BP
↑pulmonary compliance
↑FRC
28
Q

Brachial Plexus

A 
Most common nerve injury
Supine when arms abducted >90°
Humeral head rotation
Lateral decubitus - stretch, traction, tension
Chest dependent compression

AS - N928 Basic Principles of Anesthesia (18 decks)

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