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Patient positioning for surgery and anesthesia in adults

Author
Marnie B Welch, MD
Section Editor
Joyce A Wahr, MD, FAHA
Deputy Editor
Marianna Crowley, MD

INTRODUCTION

Positioning the patient for a surgical procedure is a shared responsibility among the surgeon, the anesthesiologist, and the nurses 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 (eg, nerve damage, pressure-induced injury or ulceration, or compartment syndrome).

This topic will discuss the basic principles for positioning and specific concerns for a variety of positions. Postoperative visual loss, which may be related to patient positioning, is discussed separately. (See "Postoperative visual loss after anesthesia for nonocular surgery".)

GENERAL CONSIDERATIONS

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 (eg, 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 position physiologically.

Physiologic changes — All positions used for surgery can cause cardiovascular and pulmonary changes. Both general and neuraxial anesthesia can affect the normal compensatory mechanisms that maintain cardiovascular stability and can cause changes in ventilation and perfusion that can result in hypoxemia. In addition, compression of tissue or vascular structures related to positioning can cause regional ischemia. The physiologic effects of specific positions are discussed individually. (See 'Physiologic effects of supine position' below and 'Physiologic effects of Trendelenburg positioning' below and 'Physiologic effects of reverse Trendelenburg position' below and 'Physiologic effects of lithotomy positioning' below and 'Physiologic effects of lateral decubitus positioning' below and 'Physiologic effects of prone positioning' below and 'Physiologic effects of sitting position' below.)

                                       
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Literature review current through: Nov 2017. | This topic last updated: Jul 25, 2017.
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