Page 8 - Part 2 Anesthesiology Common Risk Issues

SVMIC Anesthesiology: Common Risk Issues

Positioning

Improper Positioning

Positioning the patient for a surgical procedure is a shared
responsibility among the surgeon, the anesthesiologist, and

the non-physician team members in the operating room. The
optimal position may require a compromise between the best

position for surgical access and the position the patient can
tolerate. The chosen position may result in physiologic changes

and can result in soft tissue injury (e.g., nerve damage, pressure-
induced injury or ulceration, or compartment syndrome).

Unfortunately, the best positioning for surgery and the patient
may not be the optimal position for administering anesthesia.

This topic will discuss the basic principles for positioning and

specific concerns for a variety of positions. Post-operative
visual loss, which may be related to patient positioning, is not

discussed.

Trial Positioning

When possible, the position during surgery should be one that

would be comfortable with the patient fully awake. Patients
should be questioned about limited range of motion and their

ability to lie comfortably in the expected position. If questions
arise, the patient should be placed in the anticipated position as

a trial before sedation or induction of anesthesia.

If the operating table will be tilted either top to bottom, side
to side, or moved into the sitting position (e.g., during breast

reconstruction) during surgery, the anticipated position should
be practiced before skin preparation and draping, to make sure

supports and straps are secure and that the patient tolerates the

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