Positions

• Surgical positions

  Positions of the body during surgical procedures

  
• Goals of surgical positioning

  • Maximum exposure to surgical area while maintaining homeostasis and preventing injury
  • Provide anaesthetist with adequate access for airway management, ventilation, medications, and monitoring
  • Promote enhancement of a satisfactory surgical result

  
• Elderly patient


  Patients who are old and frail
• Considerations for positioning elderly patients

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


  Patients who are children
• Considerations for positioning paediatric patients

  • Appropriate size for bed and attachments
  • May need to use safety straps
  • Never overextend limbs or keep in one position for longer periods
  • Prone to physiological compromise due to small size
• Supine position


  Position of the body lying flat with face and abdomen up and arms tucked in at the sides
• Supine position

  • Allows access to peritoneal, thoracic and pericardial regions, as well as head, neck and extremities
  • Carries risk of supine hypotensive syndrome during pregnancy or with large abdominal mass
  • Can lead to loss of natural lumbar lordosis and associated postoperative low back pain
• Maintenance of lordosis with inflatable wedge or other suitable device should be considered in all patients
• Occiput, sacrum and heel are at risk of developing pressure sores and should be well padded
• Supine position


  Leads to loss of the natural lumbar lordosis and is associated with postoperative low back pain
• Maintaining lordosis


  Should be considered in all patients using an inflatable wedge or another suitable device
• Occiput, sacrum and heel


  • At risk of developing pressure sores and these areas should always be well padded
• Heel pads


  If used, the knee should still maintain some degree of flexion otherwise a hyperextension injury may result
• Seated position


  Patient sits straight up or leaning slightly, performed in some dental and neurosurgeries
• Seated position


  • Requires careful support of the head, venous pooling and resultant cardiovascular instability may occur (particularly, risk of hypotension)
• Craniotomy

  Air embolism is a severe potential problem because veins within the bone are sub-atmospheric, air may enter the veins leading to systemic air embolism
• Lithotomy position


  Patient's feet are positioned above the hips
• Lioyd Davis position


  Patient's feet are positioned at the same level as the hips
• Lithotomy and Lioyd Davis positions are common for surgical procedures involving pelvis and lower abdomen (such as: anal surgeries, cystoscopy, curettage and cervical cerclage)

  
• Lithotomy and Lioyd Davis positions


  • May result in nerve damage on the medial or lateral side of the leg from pressure exerted by the stirrups, which must be well padded
• Lithotomy and Lioyd Davis positions


  • Care must be taken to elevate both legs simultaneously to avoid pelvic asymmetry and resultant backache
• Lithotomy and Lioyd Davis positions

  • 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, performed in some operations such as laminectomy

  
• ﻟﺸﺮج، وﺗﻨﻈﯿﺮ اﻟﻤﺜﺎﻧﺔ، واﻟﻜﺸﻂ، وﺗﻄﻮﯾﻖ ﻋﻨﻖ اﻟﺮﺣﻢ


  ﻗﺪ ﯾﺆدي ذﻟﻚ إﻟﻰ ﺗﻠﻒ اﻷﻋﺼﺎب ﻓﻲ اﻟﺠﺎﻧﺐ اﻷوﺳﻂ أو اﻟﺠﺎﻧﺒﻲ ﻣﻦ اﻟﺴﺎق ﺑﺴﺒﺐ اﻟﻀﻐﻂ اﻟﺬي ﺗﻤﺎرﺳﮫ اﻟﺮﻛﺎﺋﺐ، واﻟﺘﻲ ﯾﺠﺐ أن ﺗﻜﻮن ﻣﺒﻄﻨﺔ ﺟﯿﺪًا
• رﻓﻊ ﻛﻠﺘﺎ اﻟﺴﺎﻗﯿﻦ


  ﻓﻲ وﻗﺖ واﺣﺪ إﻟﻰ ﻋﺪم ﺗﻨﺎﺳﻖ اﻟﺤﻮض وﺗﺠﻨﺐ آﻻم اﻟﻈﮭﺮ اﻟﻨﺎﺗﺠﺔ
• دﻋﻢ اﻟﻌﺠﺰ


  ﻋﻠﻰ طﺎوﻟﺔ اﻟﻌﻤﻠﯿﺎت وﻋﺪم اﻟﺴﻤﺎح ﻟﮫ ﺑﺎﻻﻧﺰﻻق ﻣﻦ اﻟﻨﮭﺎﯾﺔ
• وﺿﻌﯿﺔ اﻻﻧﺒﻄﺎح


  ﺗﺘﻀﻤﻦ اﻟﻮﺿﻌﯿﺔ اﻟﺘﻲ ﯾﺴﺘﻠﻘﻲ ﻓﯿﮭﺎ اﻟﻤﺮﯾﺾ ﺑﺸﻜﻞ ﻣﺴﻄﺢ ﻣﻊ وﺿﻊ اﻟﺼﺪر ﻟﻸﺳﻔﻞ واﻟﺨﻠﻒ ﻓﻲ ﺑﻌﺾ اﻟﻌﻤﻠﯿﺎت ﻣﺜﻞ اﺳﺘﺌﺼﺎل اﻟﺼﻔﯿﺤﺔ اﻟﻔﻘﺮﯾﺔ
• وﺿﻌﯿﺔ اﻻﻧﺒﻄﺎح


  ﻗﺪ ﯾﺴﺒﺐ ﺿﻐﻄًﺎ ﻋﻠﻰ اﻟﺒﻄﻦ، وﻟﻤﻨﻊ ذﻟﻚ ﯾﺠﺐ ﺗﻮﻓﯿﺮ اﻟﺪﻋﻢ ﺗﺤﺖ اﻟﻜﺘﻔﯿﻦ واﻟﻘﻤﻢ اﻟﺤﺮﻗﻔﯿﺔ، وﯾﺠﺐ ﺗﺠﻨﺐ اﻟﺘﻤﺪﯾﺪ اﻟﻤﻔﺮط ﻟﻠﻜﺘﻔﯿﻦ
• وﺿﻌﯿﺔ اﻻﻧﺒﻄﺎح

  1. ﯾﺠﺐ ﺣﻤﺎﯾﺔ اﻟﻮﺟﮫ، وﺧﺎﺻﺔ اﻟﻌﯿﻨﯿﻦ، ﻣﻦ اﻟﺼﺪﻣﺎت

  2. ﯾﺠﺐ ﺗﺜﺒﯿﺖ أﻧﺒﻮب اﻟﻘﺼﺒﺔ اﻟﮭﻮاﺋﯿﺔ ﺑﺈﺣﻜﺎم ﻓﻲ ﻣﻜﺎﻧﮫ ﺣﯿﺚ ﯾﻜﺎد ﯾﻜﻮن ﻣﻦ اﻟﻤﺴﺘﺤﯿﻞ إﻋﺎدة إدﺧﺎﻟﮫ واﻟﻤﺮﯾﺾ ﻓﻲ ھﺬا اﻟﻮﺿﻊ
• اﻟﻮﺿﻊ اﻟﺠﺎﻧﺒﻲ


  ﯾﺴﺘﻠﻘﻲ اﻟﻤﺮﯾﺾ ﻋﻠﻰ ﺟﺎﻧﺒﮫ اﻷﯾﻤﻦ أو اﻷﯾﺴﺮ، وﯾﺴﺘﺨﺪم ﻓﻲ ﺑﻌﺾ اﻟﻌﻤﻠﯿﺎت ﻣﺜﻞ ﺟﺮاﺣﺎت اﻟﻜﻠﻰ واﻟﺼﺪر
• اﻟﻮﺿﻊ اﻟﺠﺎﻧﺒﻲ


  ﻗﺪ ﯾﺆدي إﻟﻰ ﻋﺪم ﺗﻨﺎﺳﻖ ﺗﮭﻮﯾﺔ اﻟﺮﺋﺔ
• اﻟﻮﺿﻊ اﻟﺠﺎﻧﺒﻲ

  1. ﯾﺠﺐ اﻟﻌﻨﺎﯾﺔ ﺑﻮﺿﻌﯿﺔ اﻟﺬراع واﻟﺤﻘﻦ اﻟﻮرﯾﺪي

  2. ﯾﺠﺐ دﻋﻢ اﻟﺤﻮض واﻟﻜﺘﻔﯿﻦ ﻟﻤﻨﻌﮭﻤﺎ ﻣﻦ اﻟﺘﺪﺣﺮج إﻟﻰ اﻟﺨﻠﻒ )ﻣﻊ ﺧﻄﺮ اﻟﺴﻘﻮط ﻣﻦ اﻟﻄﺎوﻟﺔ( أو إﻟﻰ اﻷﻣﺎم ﻓﻲ وﺿﻌﯿﺔ اﻹﻓﺎﻗﺔ
• ﻣﻮﻗﻒ ﺗﺮﻧﺪﻟﻨﺒﻮرغ

  ﯾﺘﻢ وﺿﻊ اﻟﺠﺴﻢ ﺑﺸﻜﻞ ﻣﺴﻄﺢ ﻋﻠﻰ اﻟﻈﮭﺮ واﻟﺮأس ﻟﻸﺳﻔﻞ واﻟﺴﺎﻗﯿﻦ ﻟﻸﻋﻠﻰ
• اﺳﺘﺨﺪاﻣﺎت ﻣﻮﻗﻒ ﺗﺮﻧﺪﻟﻨﺒﻮرغ

  • اﻟﻤﺮﺿﻰ اﻟﺬﯾﻦ ﯾﻌﺎﻧﻮن ﻣﻦ اﻧﺨﻔﺎض ﺿﻐﻂ اﻟﺪم أو اﻟﺼﺪﻣﺔ
  • اﻟﺘﺨﻔﯿﺾ اﻟﺠﺮاﺣﻲ ﻟﻔﺘﻖ اﻟﺒﻄﻦ
  • ﻣﻨﻊ ﺷﻔﻂ ﻣﺤﺘﻮﯾﺎت اﻟﻤﻌﺪة ﺑﺴﺒﺐ اﻟﻘﻲء أو اﻟﻘﻠﺲ
  • ﻋﻨﺪ وﺿﻊ ﺧﻂ ورﯾﺪي ﻣﺮﻛﺰي
• ﻣﻮﻗﻒ ﺗﺮﻧﺪﻟﻨﺒﻮرغ

  ﻗﺪ ﯾﺆدي إﻟﻰ ﺿﻐﻂ ﺗﺼﺎﻋﺪي ﻋﻠﻰ اﻟﺤﺠﺎب اﻟﺤﺎﺟﺰ ﺑﺴﺒﺐ وزن اﻟﺒﻄﻦ
• ﻣﻮﻗﻒ ﺗﺮﻧﺪﻟﻨﺒﻮرغ

  ﻗﺪ ﯾﺤﺪث ﺗﻠﻒ ﻓﻲ اﻟﻀﻔﯿﺮة اﻟﻌﻀﺪﯾﺔ ﻧﺘﯿﺠﺔ ﻟﻠﻀﻐﻂ ﻣﻦ دﻋﺎﻣﺎت اﻟﻜﺘﻒ، ﺧﺎﺻﺔ إذا ﺗﻢ إﺑﻌﺎد اﻟﺬراﻋﯿﻦ
• وﺿﻊ ﺗﺮﻧﺪﻟﯿﻨﺒﻮرغ اﻟﻌﻜﺴﻲ


  ﯾﺘﻢ اﺳﺘﺨﺪام وﺿﻌﯿﺔ اﻟﺘﺮﻧﺪﻟﯿﻨﺒﻮرغ اﻟﻌﻜﺴﯿﺔ أﯾﻀًﺎ ﻓﻲ ﺟﺮاﺣﺔ اﻟﺮﻗﺒﺔ واﻟﺮأس واﻟﻌﻤﻠﯿﺎت اﻟﻨﺴﺎﺋﯿﺔ ﻷﻧﮭﺎ ﺗﻘﻠﻞ ﻣﻦ ﺗﺪﻓﻖ اﻟﺪم إﻟﻰ ﺗﻠﻚ اﻟﻤﻨﺎطﻖ
• Trendelenburg position


  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, especially if the arms are abducted