Patient Position During Anesthesia：麻醉期间病人的位置.pptVIP

Supporting devices for Prone Support of the thorax with firm bolsters which are placed under the patients sides from clavical to iliac crest. This allows the belly to hang free and increases ventilation while preventing aorto-caval compression. Breasts are placed medial and cephalad while genitals are insured to be non compressed. Arm placement in Prone pts Placement of the arms is either at the sides of the patient or forward alongside the head on padded arm boards. Padding of the elbow is required. Abduction of the arms should be limited to less than 90 degrees to prevent excessive stretch of the brachial plexus. Ankles may be supported with a bend in the knees to reduce stretch to the lumbar spine. Calf compression stockings are routinely used to prevent venous stasis or blood pooling with reduction in DVT. Complications of Prone Position Prone position is one of the more challenging positions to the anesthetist. Eye and ear injuries are more common in this position. Eye protection with Opti-guard is warranted. Scleral edema is common in prone patients. Blindness. Permanent loss of vision can occur after nonocular surgical procedures especially in patient in the prone position! Spine surgery with its blood loss, hypotension and anemia may all conspire together to produce optic nerve ischemia. Additional Prone Problems Neck injuries due to misalignment. Brachial plexus injuries due to excessive stretch or misalignment of shoulders. Breast or genital injuries causing pain or dysfunction. Not good. Medial placement of breasts is recommended. Abdominal compression injuries may be alleviated with the use of bolsters. Prone Problems Knee injuries are especially prevalent in the obese or in those with pathologic conditions of the knees preoperatively. Document and pad the knees heavily. Injury to the dorsum of the feet is also possible. Thoracic Outlet syndrome. How do you test for it? Did you forget about POVL in the Prone position? Sitting Position See