TBR Positioning Patient ORTO II

TEXT BOOK READING
PATIENT POSITIONING AND

SPINE SURGICAL
Srilina Thayeb
INTRODUCTION
Positioning a patient for surgical prosedure

is frequently a compromise between what
the anesthesized patient can tolerate.
What the surgical team requires for access

to their anatomic targets.
INTRODUCTION
Physiologic instability resulting from

disease or injury may be manified by
rapidly moving seriously ill patient from
bed to transport cart and onto
operating table.
Induction of anesthesia and
positioning may need to delayed until
that patient is hemodinamically stable.
Very important for anesthesiologist
to understant the physiologic and
potential pathologic consequency of
patient positioning.
The lack of solid scientific

information on basic mechanism of
positioning related complications
often leads to medicolegal
entanglements.
Dorsal decubitus positions
SUPINE
- Horizontal : the arm are padded and
restrained alongside the trunk or abduced on
padded arm boards, this does not place the
hips and knee in a neutral position, resulting
in discomfort for awake patients
- Contoured : the arm are pleced as for the
horizontal position; the hips and knee are
slightly flexed; this good position for routine
use
- Lateral uterina or abdominal mass
displacement; leftward tilt of the
table or placement of a wedge
under the right hip
LITHOTOMY
- Standart; the ower extremitas are flexed
at the hips and knee and simultaneously
elevated to expose the perineum; at the
end surgery, both legs are lowered
together to minimize torsion stress on the
lumbar spine
- Exeggated; this stresses the lumbar spine
and restricts ventilation because of
abdominal compresion by the thighs
Head Down Tilt; this should be avoid in
patients wih intracranial pathology
- Trendelenberg position; this may require
some means for preventing the patients from
sliding cephalad; shoulder braces should be
avoid if possible; this position should only be
used when a unique surgical issues requires
it for exposure and only for as long a needed
Complication of dorsal decubitus
positions
Postural hipotension; this is most common
complication of the head up position; the legs should
be lowered simultaneously from lithotomy position if
patient has hipovolemik
Pressure alopecia; padded head support should be
used
Pressure point reactions; to the elbows, or sacrum,
these shouldbe protected agains skin and soft tissue
compression and iskemia, but there is no
evidencethat is beneficial in reducing peripheral
neuropathies in the perioperative period
Lateral decubitus position
Standart ( Horizontal ) Lateral position
the downside thigh and knee are flexed, and pillows are
placed between the legs and under the head tomaintain
alignment of the cervical and thoracic spines
Flexed Lateral position
- Lateral jacknife; the downside iliac crest is over the
table hinge to allow stretch of the upside flank, venous
pooling occurs in the legs
- Kidney; an eleveted table rest under the iliac crest
further increases lateral flexion to expose the kidney;
venous pooling and ventilation to perfusion mismatch
may occur
Complications of lateral decubitus
positions
Damage to the eyes or ear ( pressure shoud be
avoid)
Neck injury (lateral flexion is a risk, aspecially
inpatient with arthritis)
Suprascapular nerve injury ( placement of a pad
caudal to the dependent axila prevents
circumduction of the nerve; injury manifests a
diffuse shoulder pain
Long Thoracic nerve disfunction may reflect lateral
flexion of the neck and stretch of the nerve
Ventral Decubitus Position
Full Prone ; supportive pads should be
used under the abdomen
Prone Jacknife
Kneeling
Complication Ventral Decubitus Positions
Damage to the eyes or ears ( pressure

should be avoided , the use of use of
protektive goggles should be considered)
Neck Injury ( an arthritic neck may be best
managed in the sagital plane, head
rotation may decrease caritid and vertebral
bloods flows)
Brachial plexus injuries
Complication Ventral Decubitus
Positions
Thoracic Outlet Syndrome ( it may be

useful to ask patients before surgery if
they are able to sleep with their arms
elevated overhead
Breast Injuries
Impaired venous return (supportive pads
should be used under the abdomen
Patient Position with Spine Surgery
Patient who undergo spine procedures in the supine

position under general anesthesia have an incresed
risk for development of perioperative visual loss. Hight
risk patient are those who undergo prolonged spine
prosedur and those who have substansial blood loss
The Anesthesiologist should consider informing high
risk patients that there is small, underpredictable risk
of perioperative bloode loss
Use of deliberate hypotensive techniques during spine
surgery has not been shown to be associated with the
development of perioperative visual loss
Patient Position with spine surgery
Use of deliberate hypotensive techniques during spine surgery has

not been shown to be associated with the development of
perioperative visual loss
Colloids should be used along with crystalloids to maintain
intravascular volume in patients who have substansial blood loss
There is no apparent transfusion threshold that would eliminate the
risk of perioperative visual loss related to anemia
High risk patients should be positioned so that the head is level or
should be maintained in a neutral forward position ( without significant
neck flexion, extension, lateral flexion or rotation) when possible
Consideration should be given to the use of staged spine procedures
in high risk patients
Patient Position with spine surgery
High risk patients should be positioned so

that the head is level or should be
maintained in a neutral forward position
( without significant neck flexion,
extension, lateral flexion or rotation) when
possible
Consideration should be given to the use
of staged spine procedures in high risk
patients
TERIMA KASIH

TBR Positioning Patient ORTO II

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TEXT BOOK READING

PATIENT POSITIONING AND

Positioning a patient for surgical prosedure

What the surgical team requires for access

Physiologic instability resulting from

The lack of solid scientific

Damage to the eyes or ears ( pressure

Thoracic Outlet Syndrome ( it may be

Patient who undergo spine procedures in the supine

Use of deliberate hypotensive techniques during spine surgery has

High risk patients should be positioned so

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