• Positioning
    • General complications
      • Ensure staff understand roles
      • IV lines, ETT and catheters should be free to move
      • Function of equipment must be reassessed after transfer
    • Repositioning checklist
      • A
        • Check ETT/LMA
      • B
        • Ventilation, auscultation, sats, capnography
      • C
        • Check BP/ECG still functioning
      • D
        • Eyes, neurovascular
      • E
        • Cables, catheters and electrodes
    • Peripheral nerve injuries
      • Stretch, compression, ischaemia or metabolic derangement
      • Identifiable mechanism only found in 10%
      • May NOT be prevented solely by avoiding GA
      • Commoner in males (3:1)
    • Ocular injuries
      • Corneal abrasions most common
      • Largely preventable by application of tape
      • Retinal ischamia a particular risk in prone position
    • Pressure sores
      • Prevent by dissipation of force
      • Positioning, padding and regular assessment are required
    • Individual positions
      • Prone
        • Physiological changes can be minimised by good positioning
        • Avoid abdominal compression (vena caval compression, diaphragm splinting)
        • A increase in FRC occurs, however which can improve oxygenation
        • Position head and neck carefully (eyes, neck and nose easily injured)
        • Limbs flexed slightly anteriorly, abducted and externally rotated to <90 degrees
        • Brachial plexus still at risk
        • Padding to avoid ulnar nerve compression
        • Dorsum of feet, pelvic area, femoral nerve, axilla, breasts and elbows are all at risk of pressure necrosis
    • Individual positions contd....
      • Supine
        • Lung volumes reduced due to cephalad movement of the diaphragm
        • Increased venous return to the heart
        • Can cause volume overload in the failing heart
        • Pregnancy can cause aortocaval compression
        • Facial and supra-orbital nerves can be crushed by ties
        • Brachial plexus injury
          • Avoid abducting by > 90ᵒ
        • Ulnar nerve compression behind medial condyle
        • Loss of lumbar lordosis leads to LBP
        • Occiput, sacrum and heels can develop pressure sores
      • Trendelenburg (head-down)
        • CV changes similar but more pronounced than supine position
        • Raised ICP, Intraocular pressure and passive regurgitation more common
      • Reverse Trendelenburg
        • Similar to seated position
        • Beneficial effects on ICP
        • Risk of hypotension and VAE
      • Lithotomy/Lloyd Davies
        • Similar to Trendelenburg complications
        • Cephalad movement of diaphragm can cause bronchospasm or endobronchial intubation
        • Digits can be crushed when leg section of the bed is replaced
        • Extreme hip flexion can cause nerve stretch (sciatic, Obturator) or compression (femoral under Inguinal ligament)
        • Common peroneal and saphenous nerves can be compressed by stirrups
        • Calf compression can dispose to VTE and compartment syndrome
      • Seated
        • CVS affected by venous pooling
        • Excessive neck flexion/extension
        • VAE during craniotomy
      • Lateral
        • Dependent lung over perfused and under-ventilated
        • Non-dependent lung over-ventilated and under perfused
        • Corneal abrasions common
        • Brachial plexus injury if head/neck have no lateral support
        • Venous hypertension in the dependent arm
        • Padding between legs to avoid peroneal and saphenous nerve injury
    • CEACCP
      Link:ceaccp.oxfordjournals.org/content/4/5/160.full.pdf?sid=ea01c70c-7dc0-43e5-ad0c-a3d4290b8e72
    • CEACCP
      Link:ceaccp.oxfordjournals.org/content/6/2/67.full.pdf?sid=952bf392-b4dd-4eda-a2ae-a84e986a292e

    • Link:www.wfsahq.org/components/com_virtual_library/media/a5da94469c304896052227a7b047c785-311-Patient-positioning-during-anaesthesia.pdf