40 Questions
What is a key consideration for everyone in the operating room regarding proper positioning?
Removing jewelry and hair ornaments
Why should pressure on the eyes be avoided during patient positioning in the operating room?
To prevent nerve injuries
What physiological change occurs in an awake patient when lying supine?
Increase in stroke volume
In the operating room setting, what is the main goal of proper positioning in relation to the surgeon's needs?
Providing maximum access to the surgical site
Why should attempts to bend a limb a certain way be avoided after anesthesia if it does not bend that way before anesthesia?
Risk of peripheral nerve injury
What should be avoided when a patient is positioned for surgery to prevent harm?
Applying pressure on the eyes
What is the recommended limit for abduction when trying to prevent ulnar neuropathies?
2 hours
Which complication is strongly related to the surgical procedure time during Lithotomy surgeries?
Compartment Syndrome
Where should the arms be positioned during Lateral Decubitus surgeries?
In front of the patient
Which position should the patient's head be kept in during Lateral Head/neck considerations?
Neutrally positioned
What is an essential precaution mentioned to avoid complications during Lateral Head/neck positioning?
Check the dependent ear
Why is it recommended to use an 'axillary roll' during certain surgeries?
To prevent brachial plexus injury
What is a patient risk factor for perioperative vision loss?
Hypertension
Which factor is recommended to be avoided to prevent central retinal artery occlusion (CRAO) during long spine surgeries?
Direct pressure on the eye
What positioning recommendation is given to high-risk patients during long spine surgeries?
Head level with or higher than the heart
Which of the following is NOT a perioperative factor associated with perioperative vision loss?
Tobacco use
What is recommended to avoid in positioning high-risk patients during long spine surgeries?
External chest compression
"Positioningrelated recommendations" in the text emphasize avoiding which aspect during surgeries?
Neck flexion
What approximate distance is there between the brain and the site of the BP cuff on the arm in the seated position?
15-30 cm
What is the typical difference between the brain MAP and the measured mean brachial artery pressure?
8-24 mmHg lower
What can happen if the beach chair position is combined with deliberate hypotension?
Severely compromised cerebral perfusion
In case of venous air embolism with a small amount of air, what happens to the air?
It enters the lungs and is absorbed into the alveoli
What are the potential outcomes of a large amount of air entering in venous air embolism?
Decreased blood pressure
Which condition is NOT associated with venous air embolism?
Increased cardiac output
What is the most likely cause of vision loss in Case Study 1 upon awakening?
Facial nerve injury
Based on the ASA Practice Advisory, what is recommended for 'high risk' patients undergoing complex spine surgery?
Frequent eye checks with no specific time frame
What was the initial reason attributed to the bilateral loss of vision noted in Case Study 2?
Residual anesthesia
Which surgery was performed in Case Study 2 that led to bilateral loss of vision?
Right laparoscopic pyeloplasty
What diagnostic tool was used to evaluate motor neuropathies according to the text?
Electromyogram
What is recommended regarding head positioning for 'high risk' patients undergoing complex spine surgery?
Keep head neutral
The approximate distance between the brain and the site of the BP cuff on the arm in the seated position is fixed at 20 cm.
False
The brain Mean Arterial Pressure (MAP) will always be equal to the measured mean brachial artery pressure.
False
Combining the beach chair position with deliberate hypotension can improve cerebral perfusion.
False
Venous Air Embolism can lead to arrhythmia, desaturation, pulmonary hypertension, circulatory compromise, and cardiac arrest.
True
When a small amount of air enters the circulation, it is absorbed by the alveoli and is easily detected.
False
A large amount of air entering the circulation can lead to an increase in EtCO2.
False
Nerve injury during surgery is a significant source of professional liability.
True
Stretch, ischemia, and compression are three common mechanisms for nerve injury during surgery.
True
Anesthetized patients can show early warning symptoms of pain if they experience nerve injury during surgery.
False
The ASA Closed Claims do not contain any information related to nerve injury during surgeries.
False
Study Notes
Perioperative Visual Loss (POVL)
- POVL is a serious complication that can occur during surgery
- High-risk patients include those undergoing complex spine surgery, those with hypertension, diabetes, atherosclerosis, morbid obesity, and tobacco use
- Intraoperative factors that contribute to POVL include prolonged hypotension, long duration of surgery, prone position, large blood loss, large crystalloid use, anemia, and hemodilution
- External compression of the abdomen or chest should be avoided
Positioning
- The entire OR team shares responsibility for proper patient positioning
- Jewelry and hair ornaments should be removed, and pad surfaces, lumbar support, and natural joint position should be maintained
- The head should remain midline, and pressure on the eyes should be avoided
Supine Position
- This is the most common position for surgery
- Hemodynamic reserve is best maintained, and the entire body is close to the level of the heart
- Complications of the supine position include pressure alopecia, prolonged immobilization of the head, and peripheral nerve injury
Lithotomy Position
- This position is used for surgeries involving the perineum, medial thighs, genitalia, and rectum
- Care should be taken to prevent dislocation of the hips
- Complications of the lithotomy position include compartment syndrome, which can result in ischemia, edema, and rhabdomyolysis
Lateral Decubitus Position
- This position is used for surgeries involving the thorax, retroperitoneal structures, or hip
- Anterior and posterior support should be provided, and arms should be positioned in front of the patient
- The dependent arm should be on an arm board, and the non-dependent arm should be supported
Prone Position
- This position is used for surgeries involving the posterior cervical spine and posterior fossa
- The patient's head should be in a neutral position, and the eyes should be securely taped
- The lower portion of each bolster or roll must be under the iliac crest
Sitting Position
- This position is used for surgeries involving the posterior cervical spine and posterior fossa
- Advantages include surgical exposure, decreased blood in the field, and reduced perioperative blood loss
- Disadvantages include venous air embolism and hemodynamic effects
Nerve Injury
- Nerve injury is a serious perioperative complication and a significant source of professional liability
- Three mechanisms of injury include stretch, ischemia, and compression
- The anesthetized patient cannot show early warning symptoms of pain, nor can reposition themselves spontaneously
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