Basics: Patient Positioning
- decrease preload, increase perivertebral pressure, increase bleeding (because higher
pressure). We can reduce this by using chest rolls to lift abdomen off table - ANS-abdominal
contents compressing vena cava does what to: preload, perivertebral pressure, surgical
bleeding?
- How can we reduce abdominal pressure on vena cava?
- foot drop
- inability to evert foot
- inability to extend toes dorsally (towards face)
- sensory loss to sole of foot - ANS-symptoms of common peroneal nerve injury include?
- lateral malleolus of dependent knee
- lateral knee of the dependent leg
- hip of dependent leg - ANS-in lateral decubitus position, what are the three potential pressure
points?
- Median nerve is involved
- inability to abduct thumb, flex distal phalanx of 2nd finger, decrease sensation lateral 3.5
fingers - ANS-Edema can lead to carpal tunnel syndrome.
Which nerve is involved and what are the symptoms?
"beach chair" position - ANS-semi-fowler allows slight flexion of hips & knees, less respiratory
compromise and minimal CV compromise
1. male (especially > 50 yo)
2. preexisting ulnar neuropathy
3. extremes in body weight
4. prolonged hospital stay/bedrest - ANS-what are the major risk factors that predispose
patients to develop ulnar nerve injury? 4x
1. Midcervical tetraplegia: associated with hyperflexion of the neck. ischemia results due to
compression/stretching of the midcervical spinal cord (C5). To decrease risk of occurrence, be
able to place two finger-breadths between chin and chest
2. Paradoxical air embolism: higher incidence but can occur in other situations that produce
pressure gradient between the atmosphere and the veins at the surgical site - ANS-what two
complications are most associated with sitting position?
why?
1. prolonged hypotension (SBP < 100mmHg)
2. long duration of surgery especailly in prone position
, 3. large blood loss
4. large crystalloid use
5. anemia/hemodilution
6. increased intraocular or venous pressure from prone position - ANS-What factors increase
risk of ION? 6x
20 min - ANS-after doing a spinal, we should wait about _______ before moving the patient as it
will hopefully decrease the risk of spinal medication moving upward
90 degrees - ANS-in supine (and many other positions), the arms can be next to the pt or out on
arm boards. Arms cannot be greater than _____ degrees angle
abd viscera displaces diaphragm cephalad, reducing lung compliance and potentially resulting
in a decrease in tidal volume - ANS-in the lithotomy position, the abdominal viscera does what?
abducted - ANS-arm is away from the body
abnormal gait, loss of quadriceps sensation, decrease knee jerk, loss of flexion of hip and
extension of knee - ANS-injury to the femoral nerve may yield which symptoms?
Advantage because it will lead to increased ventilation in dependent lung which leads to more
proportionate V/Q - ANS-During spontaneous ventilation cephalad displacement of the
diaphragm may be a (advantage/disadvantage)
Allows for better surgical access to the kidney.
- Venous return can be compromised
- Head is in proper alignment
- Arm is not abducted >90 degrees - ANS-Flexed lateral decubitus is beneficial for .....
- What occurs with a venous return?
- How is the head aligned?
- Arm is abducted how far?
Anesthesia and Positive end-expiratory pressure (PEEP) - ANS--further ↑ mean intrathoracic
pressure leading to greater ↓ venous return
Anesthesia effects on Positive pressure ventilation - ANS-↑ intrathoracic pressure leading to ↓
venous return, this may significantly affect cardiac filling and consequently decrease cardiac
output.
arms are abducted >90 degrees and head is rotated to one side - ANS-the highest risk of
stretch injury to the brachial plexus is when the ______
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