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The aim of optimal positioning for surgery is to perioperative nerve injury is the second most
provide the best surgical access while minimiz- common class of injury (16%). Death (32%)
Key points
ing potential risk to the patient. Each position and brain damage (12%) are rated first and
Safe positioning requires carries some degree of risk and this is magnified third. These injuries can be severely debilitating
planning and good in the anaesthetized patient who cannot make and, to complicate matters, are often asymp-
communication between the others aware of compromised positions. Com- tomatic for several days after sugery. The tradi-
anaesthetist and surgeon.
monly adopted positions include supine, litho- tionally held view that these injuries can be
Adequate numbers of skilled tomy, Lloyd Davies, lateral, seated and prone. prevented/reduced by avoiding general anaes-
personnel are required at the Many of these are modified with the addition thesia are not supported by a recent prospective
Continuing Education in Anaesthesia, Critical Care & Pain | Volume 4 Number 5 2004 DOI 10.1093/bjaceaccp/mkh044
160 The Board of Management and Trustees of the British Journal of Anaesthesia 2004
Patient positioning in anaesthesia
Continuing Education in Anaesthesia, Critical Care & Pain | Volume 4 Number 5 2004 161
Patient positioning in anaesthesia
162 Continuing Education in Anaesthesia, Critical Care & Pain | Volume 4 Number 5 2004
Patient positioning in anaesthesia
pressure on the abdomen (Fig. 2). The consequences of a high of the ulnar nerve in the cubital tunnel and indirect compression of
intra-abdominal pressure are inferior vena caval compression, the axillary neurovascular bundle by axial pressure from the
reduced venous return and subsequent poor cardiac output. humerus. The dorsum of the foot as well as knees, pelvic area,
Associated pulmonary problems are caused by an increase breasts, axilla, elbows and face are all at risk of pressure necrosis
in transdiaphragmatic pressure leading to reduced thoracic in this position. Care should be taken to ensure that all these
compliance. areas are properly supported and padded throughout the
An increase in FRC, changes in diaphragmatic excursions procedure.
and improved ventilationperfusion matching can significantly
improve oxygenation in the prone position. This technique has
been utilized for treatment of refractory hypoxaemia and in early
acute respiratory distress syndrome 7080% of patients turned
prone initially benefit from improved oxygenation. Key references
However, this position is most frequently associated with
position-related injuries. Many of these can be avoided if adequate Warner MA. Perioperative Neuropathies. Mayo Clin Proc 1998; 73: 56774
Continuing Education in Anaesthesia, Critical Care & Pain | Volume 4 Number 5 2004 163