8 Types Of Patient Positioning During Surgery4
It is necessary to remember that right position on the operating table can affect a state of the patient considerably. Possible pathological reactions, associated with the position of a body, often happen in the presence of cardiovascular failure, hypovolemia, a pathology of respiratory system etc.
Spine position during surgery is the most safe. During total anaesthesia at spontaneous breath due to pharynx musculation relaxation the root of tongue can sink down and hence obstruct respiratory tracts.
Spine position with medical cushions
Spine position can be modified by adding medical cushions: under shoulders – for operations on a neck and in the field of clavicles, under the inferior ribs – for operations on a liver and bilious paths. For proctologic, urological and gynecologic operations spine position is modified by the feet, moved apart to the sides on special supports, with flexion in coxofemoral and knee joints.
Spine position with head on stilts
Spine position with head on stilts is carried out when a skull is involved into surgery. During laying of the patient it is necessary to fix carefully his head, avoiding excessive pressure of the fixating device on soft tissues of a head. It's also important to fix an endotracheal tube carefully as access to it will be impeded during operation.
Fowler's position is applied at operations on a head and neck, at laparoscopic operations, fundoplications and cardiomyotomy. The patient is standing on the back with lifted head and lowered legs. Uprise of the main extremity of a table on 30-40 degrees is the additional action reducing probability of the passive stomachal efflux in pharynx. At patients with a serious heart pathology such position can lead to disturbance of venous return (pre-load) and to the considerable decreasing of cardiac output and arterial pressure.
At Trendelenburg position the head is positioned in such a way, that the pelvis is above shoulders. It is reached by a declination of the head on 15-30 degrees. Use of this position causes travel of intestines to the upper abdomen that improves the review and access to the pelvic organs, therefore the yielded position is used at gynecologic and urological operations, as well as those on a rectum. Also Trendelenburg position is used in intensive care units in order to enrich the blood supply of a brain at acute anaemia, shock, collapse and to prevent aspiration of vomitive masses during total anaesthesia. It is important to remember that Trendelenburg position can lead to acute hemodynamic violations, leading to a cardiac disturbances, hematencephalons, amotio of a retina. It is positioned that transfer of the patient in this standing is accompanied by venous inflow augmentation to heart. At the stable state of a patient Trendelenburg position will cause moderate rising of arterial and venous pressure. These changes can be strengthen due to drugs lowering a vascular tonus (ganglioplegic ones, use of neuroleptics, deep total anaesthesia).
Side position during surgery is used at operations on a back cranial fossa as well as operations on thorax organs, a spinal cord and for lateral access at intrathoracic operations or with the enclosed medical cushion – for operations on nephroses, liver and biliary paths. Ventilation-perfusion coefficient is a parameter that may change dramatically during side position. In the inferior lung ventilation drops and perfusion prevails. At intrathoracic operations sputum and a blood from may pass from the injured lung to the health one. To prevent this it is necessary to use special tools protecting a healthy lung – an intubation with a double-lumen tube, one-lung intubation, blockage of bronchi. It is important to track oxygenation and prevent hypoxia. Veins (both peripheric, and central) are catheterized on the side which will stay above after rotational displacement. Otherwise rate of infusion may be too slow.
Abdomen position during surgery is used to perform operations on lungs and postmediastinum from posterolateral access, on a skull, and also at some other operations. Carrying out total anaesthesia at such position is possible only after trachea intubation and the onset of lung ventilation. Rotational displacement of the patient on an abdomen is carried out after the end of induction.
Sitting position during surgery is suitable for operations on a back cranial fossa. As a previous position it is attached after introduction in anaesthesia. Before climbing the patient anesthesiologist estimates system hemodynamic. Due to the possibility of orthostatic reaction development (because of relative hypovolemia and activity anesthetic agents activity) climbimg of the patient may be carried out carefully within 10-15 minutes.