P P D A ATIENT OSITION URING NESTHESIA By David Roy Godden CRNA, MSN L O ECTURE BJECTIVES Gain an understanding of safe positioning basics   State the correct hand and arm positioning for   supine, lateral decubitus and prone positions. Be able to recite the potential nerve injuries of each   patient position. Identify the complications of the sitting position.  O C ’ BJECTIVES ON T Define and understand the hemodynamics of   each patient position. Understand and be able to verbalize the   respiratory responses of differing patient positions while awake and under general anesthesia. Understand the process and risks of Field   Avoidance – the turned patient. Discuss Post Operative Visual Loss (POVL) Case   Study: Complications of Prone position L K P OOK FOR EY OINTS Positioning is often a compromise between what is   required for surgical exposure and patient comfort! Do not place sedated or anesthetized patients in positions that they are not comfortable with when awake. If in doubt about patients safety have the patient   assume the position on the OR table before induction to see how they tolerate the position. Patient positioning is the joint responsibility of OR   Nursing, Anesthesia and Surgery. All three individuals and groups that represent them will be held liable if errors in positioning cause patient harm. Document! D P OCUMENTATION OF OSITIONING The only thing that represents what was done in   the operating room in a court of law is your testimony and your documentation. How much do you think you can remember from one case to the next and how much of your “story” will the court officers “believe” without your careful documentation in the anesthesia record? What to document? Pre-operative patient   limitations in movement strength and nerve abnormalities. Does the patient have numbness tingling or loss of sensation to any extremity pre- operatively? Does the patient have foot drop? M I ASK NJURIES Potential for corneal abrasion is always present   when mask ventilating patients. Keep hanging badges away from the patients face   when hand ventilating (don’t use the term "Bagging the pt”). Always remember the ABC’s.   Where does “E” come in the ABC lineup?   When do you tape the eyes closed knowing all of the   above. A controversial question. M I ASKING NJURIES Face straps which are tight across the patients   face with prolonged use may cause injury to the facial nerve. What are the five branches of the facial nerve remembering the mnemonic, “Two zebras bit my cat” The bucal branch is most likely injured with a face strap compression. Temporal   Zygomatic   Bucal   Mandibular   cervical  D D P ORSAL ECUBITUS OSITIONS Humans, giraffes and dinosaurs share one thing in   common. What is it? Gravity effects blood flow and much of pulmonary   mechanics. In the supine position gravity equalizes blood   pressure gradients between heart and arteries in the head and lower extremities C A P ORRECT NATOMICAL OSITION What is the ventral   surface? What is the dorsal   surface Note: Dorsal to   dorsal and ventral to ventral