IHS Surgical Positioning

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IHS Surgical Positioning
2014-06-01 15:11:32
IHS CRNA Surgical Positioning

IHS Surgical Positioning
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  1. Supine - cardiovascular
  2. Supine - pulmonary
    minimal unless large belly - then it will decrease FRC
  3. Supine - injury
    • ulnar nerve
    • pressure alopecia
    • back ache
  4. How should the arms be positioned while supine?
    • less than 90 degrees abduction
    • hand/forearm supinated/neutral
  5. What are two variations of supine?
    frog leg, lawn chair
  6. Trendelenburg - cardiovascular
    increases venous return
  7. Trendelenburg - pulmonary
    decreases FRC and lung compliance
  8. Trendelenburg - injury
    brachial plexus if shoulder braces are used, increased ICP/IOP, facial and airway swelling, aspiration
  9. Reverse Trendelenburg - cardiovascular
    decreased venous return = decreased BP
  10. Reverse Trendelenburg - injury
    decreased cerebral perfusion
  11. Lithotomy - cardiovascular
    increased preload (d/t leg elevation)
  12. Lithotomy - pulmonary
    decreased lung compliance, decreased Vt
  13. Lithotomy - injury
    • Common Peroneal nerve,
    • increased ICP,
    • potential torsion of lower spine,
    • lower extremity compartment syndrome (increased with long surgery time)
  14. Lateral Decubitus - cardiovascular
    increased pulmonary blood flow to dependent (under ventilated lung) = VQ mismatch
  15. Lateral Decub - Pulmonary
    • VQ mismatch - worsened with one lung ventilation for lung surgery
    • Decreased compliance and FRC of dependent lung
  16. Lateral Decub - injury
    brachial and ulnar nerve injuries from pressure points
  17. Prone - cardiovascular
    maintained if abdomen hanging freely
  18. Prone - pulmonary
    ok if abd hanging freely
  19. Sitting - cardiovascular
    • risk of air embolism (dural venous sinuses)
    • significant hypotension when being placed in position
  20. Sitting - pulmonary
    benefits: improved ventilation, access to airway
  21. Ways peripheral nerves are damaged:
    • compression
    • stretch
    • ischemia
    • metabolic derangement
    • direct trauma/laceration
  22. Where does the ulnar nerve originate?
    C8-T1 root
  23. Ulnar nerve damage symptoms:
    • inability to abduct or oppose 5th finger
    • decreased sensation of 5th and 1/2 of 4th finger
    • atrophy --> claw hand
  24. How to prevent ulnar nerve damage?
    maintain arm supinated/neutral
  25. Brachial Plexus cause:
    • > 90 degrees abduction of arm
    • lateral rotation of head
    • asymmetric retraction of the sternum
    • direct trauma
  26. Radial Nerve Injury symptoms:
    • wrist drop
    • inability to abduct the thumb or extend the metacarpophalangeal joints
  27. Median Nerve Injury caused by:
    AC fossa IV insertion
  28. Median nerve injury symptoms:
    Inability to oppose 1st and 5th finger, decreased sensation over the palmar area
  29. Sciatic and Common Peroneal Nerve symptoms
    • foot drop
    • inability to extend toes in dorsal direction
    • inability to evert the foot
  30. Femoral neuropathy symptoms:
    • decreased flexion of the hip
    • decreased extension of the knees
    • loss of sensation over superior thigh
    • loss of sensation over medial/anteromedial leg
  31. Obturator neuropathy symptoms:
    • inability to adduct the leg
    • decreased sensation over medial thigh
  32. What increases your risk for ION and CRAO?
    • prolonged hypotension
    • long duration in prone position
    • large blood loss
    • large crystalloid use
    • anemia/hemodilution
    • increased IOP/ICP