Surgical positions

• Goals of Surgical Positioning

  • Maximum exposure to the surgical area while maintaining homeostasis and preventing injury
  • Position must provide the Anesthetist with adequate access to the patient for airway management, ventilation, medications, and monitoring
  • Promote the enhancement of a satisfactory surgical result
• Positioning of Elderly Patient

  • Fragile skin surfaces
  • Arthritic joints
  • Limited range of motion
  • Lifting rather than sliding or dragging
  • Avoid of adhesive tape for strapping
  • Adequate padding for bony prominences
• Positioning of Paediatric Patient

  • Think of 'appropriate size'
  • Right size for bed and attachments
  • May necessary to use safety strap
  • Never overextended limbs or keep in one position for longer periods
  • Due to small size, children are prone to and has greater risk of physiologically compromised
• Supine position


  The most common surgical position, lying flat with the face and abdomen up with arms tucked in at the sides
• Supine position


  • Allows access to the peritoneal, thoracic and pericardial region; as well as the head, neck and extremities
  • Risk of supine hypotensive syndrome during pregnancy or patients with a large abdominal mass
  • Loss of the natural lumbar lordosis associated with postoperative low back pain
  • Occiput, sacrum and heel are at risk of developing pressure sores
• Seated position


  Patient sitting straight up or leaning slightly, performed in some dental and neurosurgeries

  
• Seated position


  • Requires careful support of the head, risk of venous pooling and resultant cardiovascular instability, risk of air embolism in craniotomy

  
• Lithotomy and Lloyd Davis positions


  Positioning of the patient's feet above (Lithotomy) or at the same level as the hips (Lloyd Davis)

  
• Lithotomy and Lloyd Davis positions


  • Common for surgical procedures involving pelvis and lower abdomen
  • Risk of nerve damage on the medial or lateral side of the leg from pressure exerted by the stirrups
  • Care must be taken to elevate both legs simultaneously to avoid pelvic asymmetry and resultant backache
  • The sacrum should be supported on the operating table and not allowed to slip off the end
• Prone position


  Patient lies flat with the chest down and back up

  
• Prone position


  • Performed in some operations such as laminectomy
  • May cause abdominal compression, support must be provided beneath the shoulders and iliac crests
  • Excessive extension of the shoulders should be avoided
  • The face, and particularly the eyes, must be protected from trauma
  • The treacheal tube must be secured firmly in place
• Lateral position


  Patient is lying on their right or left side

  
• Lateral position


  • Used in some operations such as kidney and thoracic surgeries
  • May result in asymmetrical lung ventilation
  • Care is required with arm position and IV infusions
  • The pelvis and shoulders must be supported to prevent from rolling either backwards or forwards

  
• Trendelenburg position


  Body laid flat on the back, the head down and legs up

  
• Trendelenburg position


  • Used for hypotensive or shocked patient, surgical reduction of an abdominal hernia, prevent aspiration of gastric contents
  • May produce upward pressure on the diaphragm because of the weight of the abdomen
  • Damage to the brachial plexus may occur as a result of pressure from shoulder supports

  
• Reverse Trendelenburg position


  Used for neck and head surgery and gynecological procedures

  
• Reverse Trendelenburg position


  • Reduces the flow of blood to the head and neck area
  • Beneficial physiological effects include an increase in head and neck venous drainage, reduction in intracranial pressure and reduced likelihood of passive regurgitation
  • Main complications are hypotension and increased risk of venous air embolism