1
Q
Supine position
A
- HD reserved
- resp: abd contents cephalad
- PNI: brachial plexus/ ulnar
- equipment: arm boards/safety straps
- lumbar support
- SCD boots
- easy access to airway/IVs
2
Q
Trendelenburg
A
- HD: cerebral vascular congestion (no glaucoma/ TBI)
- resp: abd contents cephalad (pressure controlled vent)
- PNI: brachial plexus, ulnar
- equipment: non skid pads, arm boards, safety strap
- facial, laryngeal edema (careful IVF)
- high risk aspiration (consider NGT)
- high risk ETT migration
3
Q
Reverse Trendelenberg
A
- HD: venous pooling, venous stasis, cerebral hypoperfusion, transducer at circle of Willis
- resp: preserved
- PNI: brachial plexus, ulnar
- equipment: safety straps, non ski pads, foot brackets
- when resuming supine, careful for rebound HTN
4
Q
Lithotomy
A
-HD: increase preload, CVP, C.O
-resp: decreased FRC, abd contents move cephalad
PNI: brachial plexus, ulnar, common peroneal, common popliteal, sciatic, observatory, lateral femoral cutaneous
-equipment: arm boards, safety straps, stirrups (candy cane, knee crutch, boot)
- pay strict attention to fingers
- raise legs simultaneously
- frequent repositioning
- avoid excess hip flexion/extension and excessive abduction
5
Q
Compartment syndrome
A
- can occur in Lithotomy and lateral decub
- occurs when there is limb ischemia, edema, rhabdomyolysis, edema, etc.
- occurs when procedure >2-3 hours
- treatment is a fasciotomy
- high risk is hypotension and vascular disease
6
Q
Lateral decubitus
A
- HD reserved
- resp: V/Q
- PNI: brachial plexus, ulnar, common peroneal, saphenous
- equipment: arm boards, safety straps, pillows, egg crates, axilla roll
- pay strict attention to dependent eye, face for swelling
- frequent suction of airway
- axilla roll placed distal to axilla fascia
- NIBP and SpO2 on dependent arm to monitor ischemia
- pad lumbar spine
- bend dependent leg and put pillows between bony prominences
7
Q
Prone
A
- HD: venous pooling SCD boots; IVC/aorta compressed by abd contents, IOVL
- resp: preserved
- PNI: brachial plexus, ulnar
- equipment: safety straps, arm boards, Allen, jackson frame, mirror, horseshoe adapter, mayfield ridge pins
- intubated and IVs on stretcher, careful EKG placement
- ETT placement upon position change
- reposition neck/head frequently to facilitate venous drainage
- eye care
- IOVL caused by hypotension, anemia, loss, (increased crystalloid use)
- monitor genitalia
8
Q
Supine position complications
A
- pressure alopecia
- aortocaval syndrome
- pressure injuries to sacram
- back ache
9
Q
Define Lithotomy position
A
Hips flexed: 80-110 degrees
Hips abducted: 30-45 degrees
Legs parallel with torso
10
Q
V/Q
A
Awake/SV: dependent = higher perfusion + ventilation dependent lung
Anesthetized/SV = better perfusion dependent; better ventilation upper lung
Anesthetized/MV = higher perfusion dependent, higher ventilation upper lung
11
Q
Advantages of sitting position
A
- superior access to airway
- better ventilation
- less blood loss in the operative field
- reduced facial swelling
- good access to shoulder
12
Q
Risks Sitting
A
- cervical spine infarct
- VAE
- quadrapeligia
- HD instability
- tongue swelling
- PNIs
13
Q
Sitting Position
A
- decreased venous return, venous pooling, decrease CPP; transducer to circle of Willis; incremental position change, pressors, Lower anesthestetic depth to support BP
- resp: preserved
- PNI: brachial plexus, ulnar,
- equipment: safety straps
- keep head/neck neutral to avoid spinal ischemia; avoid flexion of neck at least 2 fingerbreadths
- monitor VAE
14
Q
VAE
A
- occurs drural sinuses, surgical procedures above heart, CVC insertion
- issues associated with: volume of air (3-5cc/kg) and rate of entrapment
- creates complete RV outflow obstruction
- put in left lateral decub and trendelenburg
15
Q
Brachial Plexus Injury
A
- located between cervical spine and axillary fascia
- stretching injury: abduct >90 degrees, shoulder not flush with chest, neck turned to side, thoracic outlet syndrome prone
- compression: axilla roll, cardiac retractors, shoulder brace
- deficit: numbness paraesthesia pain in entire arm, inability to mobilize arm
16
Q
Ulnar Nerve
A
- medial side of arm in between olecranon and medial epicondyle
- stretching during flexion of arm and during extension can cause dislocation over the medial epicondyle
- compression is pronated hands
- deficit: pain/numbness in 4/5 digit, inability to grip, inability to abduct pinky, claw hand 48-72 hours
17
Q
Radial Nerve
A
- sits on lateral side of numerous
- injury occurs with lateral compression from IV pole, continuous NIBP, mismatched arm board, screen, retractor
- deficit includes: Saturday night palsy, inability to extend arm, inability to extend hand, pain and numbness in lateral arm and hand
18
Q
Common peroneal nerve
A
- branch of sciatic; runs lateral side of leg
- injury from lateral compression from: candy cane stirrup, or lateral side lying position
- deficit: foot drop, inability to evert foot, inability to extend the toes dorsally
- pad lateral aspect of leg, reposition frequently, use boots instead of candy cane stirrups
19
Q
Sciatic nerve
A
- runs over the sciatic notch and neck of femor
- injury from hyper flexion of hip, hyper extension of knee while stretching, and excessive external rotation of hip
- Deficit: foot drop, pain and numbness below the level of the knee, numbness in lateral calf
20
Q
Saphenous vein
A
- runs medial aspect of leg
- injury often from medial compression from a support in Lithotomy position or from compression during lateral decubitus position
- deficit: results in paresthesia in medial and anteromedial aspect of leg
- reposition and pad securely
21
Q
Femoral nerve injury
A
- located lumbar spine runs through pelvic brim
- injury with compression at pelvic brim, excessive angulation of thigh/ excessive rotation of hips
- results in loss of flexion of hip and extension of knee; decreased sensation over superior thigh
Intro to Anesthesia
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Decks in class (15)
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