Summary

In study session III you have learnt

• Positioning of a patient refers to a body position or arrangement of the body part that is maintained by or imposed on a patient in the course of a particular diagnosis or treatment. The main purpose of surgical positioning is to maximize anatomic exposure for the surgical procedure to allow the procedure to be performed as simply as possible and to achieve the best possible results.
• Supine position is a position of lying on the back or with the palm of the hand facing upwards. It is the most common position for surgery, induction of anesthesia and air way management. Because the entire body is close to the level of the heart, hemodynamic reserve is best maintained.
• The Trendelenburg position is tilting a supine patient head down is often used to increase venous return during hypotension and to improve exposure during abdominal surgery. The head-down position leads to decreased functional residual capacity, swelling of the face, conjunctiva, larynx, and tongue with an increased potential for postoperative upper airway obstruction.
• The reverse Trendelenburg position is supine with the head tilted upward, is often employed to facilitate upper abdominal surgery by shifting the abdominal contents caudal. The position of the head above the heart reduces perfusion pressure to the brain and blood pressure.
• Pressure alopecia, backache and peripheral nerve injury may be serious perioperative complication with a multifactorial etiology in supine trendelenburg and antitrendlenburg position.
• Lithotomy position is a position for surgical procedures (gynecologic, rectal, and urologic surgeries) or medical examinations in which the hips are flexed 80 to 100 degrees from the trunk and the legs are abducted 30 to 45 degrees from the midline. The lithotomy position causes the abdominal viscera to displace the diaphragm cephalad, reducing lung compliance and potentially resulting in a decreased tidal volume.
• The lateral decubitus position is most frequently used for surgery involving the thorax, retroperitoneal structures, or hip.
• The prone or ventral decubitus position is lying face downwards, used primarily for surgical access to the posterior spine, the buttocks and perirectal area, and the lower extremities.
• When general anesthesia is planned, the trachea is first intubated while the patient is still on the stretcher, and all intravascular access is obtained as needed.
• The face should be rechecked if any patient motion occurs during surgery, or if the table is significantly repositioned. The prone position is a risk factor for perioperative visual loss.
• Eyes should be closed and taped shut to prevent drying and scratch when performing routine anesthesia care around the face.
• Ensure that there is not excessive pressure on any one area of the body, pressure points should be padded.
• Laryngoscopy and insertion of an oral airway must be gentle and not forced. Care should be taken to prevent trauma to lips, teeth, and tongue.
• Arms should be positioned at the patient's side. The patient's arms should be less than 90 degrees, if positioned on an arm board. If greater than 90 degrees, trauma to the brachial plexus, a large nerve which supplies the upper extremities, may occur due to stretching.
• If tourniquet is used for a surgical procedure, it should not be inflated for more than120 minutes