Stoelting Study 14 Positioning

Front 1

2. Whose responsibility is the intraoperative position of the anesthetized patient?

Back 1

2. The position the patient is placed in intraoperativ~ly while under general anesthesia is til! responsibility of the anesthesiologist, surgeons, and nurses. The responsibility is shared among these operating room personnel. During the course of surgery the responsibility becomes primarily that of the anesthesiologist, who must be aware of any changes in the patient's position that have occurred intraoperatively

Front 2

4. How does the supine position affect lung perfusion?

Back 2

4. The supine position produces more evenly distributed blood flow throughout the lung.

Front 3

50 How much does the functional residual capacity change when a patient's position is changed from standing to supine?

Back 3

5. The functional resiwal capacity decreases by about 800 mL when a patient's · position i~ changed tom standing to supine, largely because of compression of the lung and cephalad displacement of the diaphragm by the abdominal contents.

Front 4

6. How does the administration of skeletal muscle paralysis affect the functional residual capacity of a patient in the supine position?

Back 4

6. The administration of skeletal muscle paralysis further decreases the functional residual capacity of a patient in the supine position. (197; .

Front 5

7. How should the patient's legs be ideally positioned during surgery in the supine position?

Back 5

7. While undergoing surgery in the supine position, the patient's legs should be positioned with slight flexirn at O)th the hips and knees. Not only does this amount of anterior abdominal wall tension during surgical closure of the abdoamount of anterior abdominal wall ternion during surgical closure of the abdomen.

Front 6

9. Why might backache result from surgery if, the supine position?

Back 6

9. Backache may result from surgery in the supine position because of the loss of the normal curvature of the lumbar spine that can occur during surgery, particulady with skeletal muscle relaxation.

Front 7

11. Describe how the patient's arms should be positioned when the patient is supine and the arms are abducted.

Back 7

11. When the supine patient's arms are abducted they should be placed on wellpadded annboards. The anTIS must be extended 90 degrees or less at the shoulder. SOffit debate exists regarding the position of the hand when the arm is abducted. It is believed that supination of the forearm may result in greater protection of the ulnar nerve from compression. Supination of the hand may result in greater stretching of the brachial plexus, however. In addition, supination of the forearm in awake patients is uncomfortable. An alternative is leaving the forearm in the neutral [Ilsinon If prooated. The neutral position is the spontaneous position of an awake, supine patient.

Front 8

12. Describe how the patient's arms should be positioned when the patient is supine and the arms are adducted.

Back 8

12. When the supine patient's arms are adducted, or tucked in to the patient's side, lL.. vv nen me supme patlent's anns are adducted, or tucked in to the patient's side, any metal surfaces or hard edges of the operating table. This can be accomplished by padding the arm circumferentially before securing it. Most often the arms are allowed to remain in the neutral position, with the palms facing the patient's side.

Front 9

13. What are the cardiovascular effects of placing the patient in the head-down position, or Trendelenburg position, for a surgical procedure? .

Back 9

13. Placement of a patient in tie head-down position, or Trendelenburg position, for a surgical procedure JesuIts in an increase in central venous pressure and myocardial work. There may be an effective decrease in stroke volume in these patients. A decreased stroke volume can result from the cephalad displacement of the abdominal contents, such that tie dhphragm impinges on the heart. In hypovolemic patients placement of the patient in the Trendelenburg position may exacerbate already present hypotension.

Front 10

15. How does the Trendelenburg position affect the patient's intracranial pressure?

Back 10

15. Placement of a patient in the head-down position for a surgical procedure results in an increase in the intracranial pressure.

Front 11

31. What is the principal potential intraoperative complication of positioning a patient in the sitting position for surgery?

Back 11

31. The principal potential intraoperative complication of po~itioning a patient in the sitting position for surgeI)' is a venous air embolism. Placing the head above the level ()f the heart during the procedure facilitates the entrainment of room air. Patients undergoing craniotomies are especially at risk, given that veins in the bony cranium do not collapse after being transected.

Front 12

35. What IS a potential problem that can result from placing a patient in the lithotomy position for more than 4 hours during a surgical procedure?

Back 12

35. Compartment syndrome secondary to inadequate circulation can result from placing a patient in the lithotomy position for more than 4 hours during a surgical procedure. The common initia.ting event is probably direct local muscle US can occur from inadequate padding, tight leg straps, or the surgeon leaning on the leg for a prolonged period of time. The direct pressure may lead to arteria; insufficiency, tissue necrosis and edema, and rhabdomyolysis.

Front 13

39. What is the usual recovery time from a peripheral nerve injury?

Back 13

39. The mua! recovery time from an intraoperative peripheral nerve injury is 3 to · 12 months. In rare cases, injury can be pennanent, particularly with stretch injury that results in disrupted axons.

Front 14

40. Which peripheral nerve is !!lost likely to manifest a postoperative neuropathy?

Back 14

40. The most common peripheral nerve to manifest a pos:operative neuropathy is the ulnar nerve.

Front 15

43. How does injury to the ulnar nerve manifest clinically? .

Back 15

Ulnar nerve injury mamests clinically as decreased sensation over the ventral and dorsal portions of the medial one and one-half fingers and an inability to abduct or cppose the fifth finger. Over time, ulnar nerve injury results in the i appearance of a "claw hand" secondary to atrophy of the intrinsic muscles.

Front 16

45. Why is the brachial plexus especially susceptible to nerve injury during surgery?

Back 16

45. The brachial plexus is especially susceptible to nerve lnjury during surgery because its course is superficial and fixed between wo points. In addition, it lies close to the clavicle and humerus, which are very mobile. (

Front 17

47. How does injury to the brachial plexus manifest clinically?

Back 17

47. Injury to the brachial plexus manifests as a limply hanging arm at the side, rotated medially, with a pronated foreann. This position of the ann is commonly · referred to as "waiter's tip.'

Front 18

65. How can the intraoperative use of a tourniquet result in nerve injury?

Back 18

65. The intraoperative use of a tourniquet can result in nerve injury, particularly if the inflation time of the tourniquet ex;;eeds 2 hours or with the application of excessive tourniquet pressures. For this reason, after about 2 hours if there is a continued need for the tourniquet it may be prudent to deflate it for 15 minutes and re-inflate it

Front 19

66. What areas of skin are especially prone to ischemic damage during surgery? How can this risk be minimized?

Back 19

66. Skin that is subject to excessive or prolonged pressure is at risk for ischemic damage. Areas of skin that are (Specially prone to ischemic damage during surgery include the heels, supraorbital ridge, and the skin at the comer of the mouth it contact with the endotracheal tube. The risk of skin ischemia can be ninimized with adequate padding at potential pressure points.

Front 20

69. How can a patient's ears be damaged intraoperatively when in the lateral position?

Back 20

69. A patient's ear can be damaged intraoperatively when in the lateral position by being folded onto itself and compressed between the patient's head and surgical table.