Intraoperative patient positioning

Published on 07/02/2015 by admin

Filed under Anesthesiology

Last modified 07/02/2015

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Intraoperative patient positioning

Roy F. Cucchiara, MD

The art and science of surgical positioning continue to evolve, but the goal remains constant: ensuring optimal surgical access to the operative site while providing a safe environment for the patient. Compromises may have to be made to surgical access so that the anesthesia provider can safely care for the patient no matter what may occur during the operation. Even more compromises may have to be made to protect the patient from injury secondary to prolonged positioning.

Both the surgeon and the anesthesia provider share responsibility for the patient’s safety with regard to the surgical position. Few data guide this principle; experience is probably an important factor, but there are no studies to support this claim. In the end, the safety of the position must be balanced against the risk of performing the operation in a position that compromises the surgeon’s access.

Commonly used positions

The basic patient positions for surgery are supine, prone, and lateral, with the head down (Trendelenburg position) (Figure 243-1) or head up (reverse Trendelenburg). Most other positions are variations on these basic ones. Lithotomy (supine) with the legs elevated and flexed (Figure 243-2), jackknife (prone and flexed), lateral decubitus (Figure 243-3), beach chair, and sitting are commonly used positioning terms.

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Figure 243-1 The Trendelenburg position. (By permission of Mayo Foundation for Medical Research and Education. All rights reserved.)
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Figure 243-2 Correct lower limb positioning in a patient in the lithotomy position. The weight of the lower leg can be distributed to the foot of the stirrup by increasing angle A between the stirrup and the support bar. (By permission of Mayo Foundation for Medical Research and Education. All rights reserved.)
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Figure 243-3 The lateral decubitus position for a patient undergoing placement of an epidural catheter. (By permission of Mayo Foundation for Medical Research and Education. All rights reserved.)

Complications resulting from incorrect positioning

The most common serious complication of poor positioning is peripheral nerve injury. Common but usually less serious complications relate to the skin. Tape “burns,” skin blisters from pressure on surfaces, and skin breakdown from the edges of an unpadded strap are common. A blister forms from abrasion of the skin or from ischemia of the skin area. Abrasions that occur in the operating room are usually shallow enough to heal over without an ulcer. The greatest care must be taken around the patient’s face and ears. Although the skin of the face is very vascular and usually heals well, an ischemic area at a fold in the facial tissue can be a serious problem, with poor healing, scarring, and possibly even the need for skin grafting. Particular care must be taken with tube tapes and tapes across the head or face to hold the tracheal tube in position.

Problems related to the trendelenburg position

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