The document discusses various patient positioning techniques used in anaesthesia and their goals, risks, and complications. It describes positions like supine, lithotomy, prone, lateral decubitus, and their effects on cardiovascular and respiratory systems. Common risks include nerve injuries, pressure sores, compartment syndrome, and visual complications. Careful patient assessment, padding of pressure points, monitoring for nerve injuries are emphasized. Position changes should be gradual and extremities checked regularly during long procedures to prevent injuries.
Anaesthesia to patiens with liver disease or a liver transplantscanFOAM
A presentation by Anna Januszkiewicz at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All available content from SSAI2017: https://scanfoam.org/ssai2017/
Delivered in collaboration between scanFOAM, SSAI & SFAI.
Neuromuscular monitoring, also known as train of four monitoring, is a technique used during recovery from the application of general anesthesia to objectively determine how well a patient's muscles are able to function. It involves the application of electrical stimulation to nerves and recording of muscle response using, for example, an acceleromyograph. Neuromuscular monitoring is typically used when neuromuscular-blocking drugs have been part of the general anesthesia and the doctor wishes to avoid postoperative residual curarization (PORC) in the patient, that is, the residual paralysis of muscles stemming from these drugs.
Anaesthesia to patiens with liver disease or a liver transplantscanFOAM
A presentation by Anna Januszkiewicz at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All available content from SSAI2017: https://scanfoam.org/ssai2017/
Delivered in collaboration between scanFOAM, SSAI & SFAI.
Neuromuscular monitoring, also known as train of four monitoring, is a technique used during recovery from the application of general anesthesia to objectively determine how well a patient's muscles are able to function. It involves the application of electrical stimulation to nerves and recording of muscle response using, for example, an acceleromyograph. Neuromuscular monitoring is typically used when neuromuscular-blocking drugs have been part of the general anesthesia and the doctor wishes to avoid postoperative residual curarization (PORC) in the patient, that is, the residual paralysis of muscles stemming from these drugs.
Patient positioning and anaesthetic consideration. Explains how positioning affects your plan of anaesthesia
Also shows what kind of positioning is required for waht kind of surgery, and what are the implications that are associated with them, including the types of complications and their management.
One must be aware of the anatomic and physiologic changes associated with anesthesia, patient positioning, and the procedure.
• The following criteria should be met to prevent injury from pressure, obstruction or stretching:
– No interference with respiration
– No interference with circulation
– No pressure on peripheral nerves
– Minimal skin pressure
– Accessibility to operative site
– Accessibility for anesthetic administration
– No undue musculoskeletal discomfort
– Maintenance of individual requirements
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
We all have good and bad thoughts from time to time and situation to situation. We are bombarded daily with spiraling thoughts(both negative and positive) creating all-consuming feel , making us difficult to manage with associated suffering. Good thoughts are like our Mob Signal (Positive thought) amidst noise(negative thought) in the atmosphere. Negative thoughts like noise outweigh positive thoughts. These thoughts often create unwanted confusion, trouble, stress and frustration in our mind as well as chaos in our physical world. Negative thoughts are also known as “distorted thinking”.
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
How to Create Map Views in the Odoo 17 ERPCeline George
The map views are useful for providing a geographical representation of data. They allow users to visualize and analyze the data in a more intuitive manner.
Welcome to TechSoup New Member Orientation and Q&A (May 2024).pdfTechSoup
In this webinar you will learn how your organization can access TechSoup's wide variety of product discount and donation programs. From hardware to software, we'll give you a tour of the tools available to help your nonprofit with productivity, collaboration, financial management, donor tracking, security, and more.
How to Split Bills in the Odoo 17 POS ModuleCeline George
Bills have a main role in point of sale procedure. It will help to track sales, handling payments and giving receipts to customers. Bill splitting also has an important role in POS. For example, If some friends come together for dinner and if they want to divide the bill then it is possible by POS bill splitting. This slide will show how to split bills in odoo 17 POS.
1. Positioning in anaesthesia
Dr. S. Parthasarathy
MD., DA., DNB, MD (Acu),
Dip. Diab. DCA, Dip. Software statistics
PhD (physio)
2. Goals
• Avoid pressure on the chest cavity
• To maintain circulation
• To prevent nerve damage
• To maintain patient’s airway
• To provide adequate exposure of the
operative site
• To provide comfort and safety to the patient
3. Positions – common
• Patient is not aware of the damage and he
cant tell that my eye is getting compressed
• supine,
• lithotomy,
• sitting,
• head-down,
• prone,
• lateral decubitus
5. Supine
• We spent most of our life like this
• Be careful
• patients with morbid obesity,
• mediastinal masses,
• poor cardiac function and
• term parturients prone to aortocaval
compression
• .
8. Supine
• prolonged contact of the back of the head
may result in alopecia
• ulnar neuropathy is the most common- males
• 0.25 % may be delayed upto 3 days
• Brachial plexus, femoral cutaneous nerves are
next common.
• Brachial or ulnar ??
9. Head rotation
putting brachial
plexus under
traction
Excess abduction of
upper limb
Forearm pronation
putting pressure on
ulnar nerve in ulnar
groove
11. RS
• cephalad movement of the abdominal contents.
• The main complications are airway obstruction
and decreased tidal volumes
• The resulting reduction in functional residual
capacity (FRC) is detrimental to gas exchange
• increase in ventilation–perfusion mismatching
and decrease in pulmonary compliance.
12. • loss of the natural lumbar lordosis
• associated with postoperative low back pain.
• The occiput, sacrum and heel are at risk of
developing pressure sores
15. Lawn Chair Position
• modification of the standard supine position
• the lower and upper halves of the body are
slightly elevated in relationship to the hips
• Better venous drainage , better muscle
relaxation
17. beach chair position
• beach chair position is associated with the
risk for cerebral underperfusion.
• Blood pressure must be maintained at a level
that guarantees a perfusion pressure of 60 to
70 mm Hg measured at the level of the
foramen magnum
19. Trendelenburg
• Central blood volume increase by 1 litre.
swelling of the face, conjunctiva, larynx, and
tongue ?? postoperative upper airway
obstruction.
• The cephalic movement of abdominal viscera
against the diaphragm also decreases
functional residual capacity and pulmonary
compliance.
20. 5 March 2017 20
Effects of Trendelenberg’ s position
• ↑ CVP
• ↑ ICP
• ↑ IOP
• ↑ myocardial work
• ↑ pulmonary venous pressure
• ↓ pulmonary compliance
• ↓ FRC
• Swelling of face, eyelids, conjunctiva & tongue
observed in long surgeries
23. Reverse Trendelenburg position(head-
up tilt)
• to facilitate upper abdominal surgery by
shifting the abdominal contents caudad.
• This position is popular because of the
growing number of laparoscopic surgeries.
• slipping on the table,
• monitoring of arterial blood pressure.
24. Reverse Trendelenburg position
• hypotension and increased risk of venous air
embolism (VAE).
• the position of the head above the heart
reduces perfusion pressure to the brain
25. Lithotomy
• This position is most often used for
• genitourinary, gynecologic, and colorectal
• Procedures.
• Hips flexed 100 deg 30-40 deg. abduction at
the hips
• . Knees 90 approx 30 deg
27. Martin and Warner have proposed a
standardized classification
• low,
standard,
• high,
• hemi,
• exaggerated,
• tilted
• Martin JT, Warner MA (Eds): Positioning in
Anesthesia and Surgery, 3rd edition. Philadelphia,
WB Saunders, 1997
32. Lithotomy
• coordinated positioning of the lower
extremities by two assistants to avoid torsion
of the lumbar spine.
• Both legs should be raised together, flexing
the hips and knees simultaneously.
• Slow removal
• Hands beware
33. lithotomy from the supine position
• Unanticipated stimulation of the carina with
bronchospasm or endobronchial intubation
may result.
• In the lithotomy position, calf compression is
almost inevitable and this predisposes to
venous thrombo embolism and compartment
syndrome ( surgery > 5 hours)
35. Lithotomy
• Lower extremity compartment syndrome is a
rare complication associated with the
lithotomy position.
• perfusion to an extremity is inadequate,
resulting in ischemia, edema
extensive rhabdomyolysis from increased
tissue pressure within a fascial compartment
36. Nerve injuries
• injury to the common peroneal nerve was
the most common lower extremity motor
neuropathy, representing 78% of nerve
injuries.
• A potential cause of the injury was the
compression of the nerve between the lateral
head of the fibula and the bar holding the
legs.
38. Exaggerated Lithotomy
• Extreme flexion of the hip
joints can cause
• neural damage by stretch
(sciatic and obturator
nerves)
• direct pressure
(compression of the
femoral nerve as it is
passes under the inguinal
ligament)
39. Hemodynamics and RS
• preload increases, transient increase in
cardiac output
• Cerebral venous and intracranial pressure in
otherwise healthy patients.
• causes the abdominal viscera to displace the
diaphragm cephalad, reducing lung
compliance and potentially resulting in a
decreased tidal volume
40. The frog-leg position
• hips and knees are flexed
• hips are externally rotated with the soles of
the feet facing each other,
• allows access to the perineum, medial thighs,
genitalia, and rectum.
• Care must be taken to minimize stress and
postoperative pain in the hips and prevent
dislocation by supporting the knees
appropriately
41. The prone or ventral decubitus
position
• used primarily for surgical access to the
posterior fossa of the skull,
• the posterior spine,
• the buttocks and
• perirectal area,
• and the lower
• extremities.
42. Prone position
Minimal neck
flexion
Face in
soft
headring
with
no
pressure
on eyes
and nose
Elbow
padded
No pressure in
axilla
Abdomen
free
anterior
flexion,
abducted
and
externally
rotated
g
e
n
i
t
a
l
n
i
p
p
l
e
43. Abdomen pressure in prone
• inferior vena caval compression,
• reduced venous return and subsequent poor
cardiac output.
• Associated pulmonary problems are caused by
an increase in transdiaphragmatic pressure
leading to reduced thoracic compliance.
44. RS – better
• An increase in FRC, changes in diaphragmatic
excursions and improved ventilation–
perfusion matching can significantly improve
oxygenation in the prone position.
• for treatment of refractory hypoxaemia and in
early ARDS
• 70–80% of patients turned prone initially
benefit from improved oxygenation
45. Prone position
• Complete obstruction of the contralateral
• vertebral blood flow with rotation of the head
>80
• Beware in old CVAs
• ‘Concorde’ position with the neck flexed and
the chin approximately one finger-breadth
from the sternum
53. The prone jackknife position
• is often used for anorectal surgery.
• is first placed prone, and all pressure
• points are padded.
• The patient is situated on the table such that
when the table is anteflexed the apex of the
inverted “V” is at the patient’s inguinal
region.
54. Knee chest position
• sigmoidoscopies or
lumbar laminectomies
Severe hypotension is
seen due to pooling of
blood in the legs
57. Watson jones ortho table
• Brachial plexus injury
– Due to > than 90* extension of the upper limb
• Lower extremity compartment syndrome
– Due to long surgeries & compression
• Pudendal nerve injury
– Due to pressure of the perineal post
68. Nerve injuries- overall
• ulnar neuropathy has been found in as many
as 26% of patients undergoing open-heart
surgery
• lower extremity neuropathy occurred in
1.5% of patients in the lithotomy position.
• The incidence of ulnar neuropathy is
estimated at 0.46% after noncardiac surgery
69. Overall mechanism of nerve injuries
• (i) stretch,
• (ii) compression,
• (iii) generalized ischaemia,
• (iv) metabolic derangement.
70. all predispose to perioperative nerve
injury
• Peripheral vascular disease,
• diabetes,
• hereditary neuropathy, and
• anatomic variation (eg, cervical rib),
75. Wedge in pregnant
• A rare complication of this positioning is
sciatic neuropathy, suggesting that time in
this position should be minimized
• Early intervention within 48 hours with EMG
studies
• no significant difference in the incidence of
ulnar neuropathy in patients undergoing
general anaesthesia, regional anaesthesia or
sedation.
77. Effects of Positioning - Obese
Patients
• Lateral:
– Well tolerated
– Correct sizing and placement of axillary roll is
important
– Ensure that pendulous abdomen does not hang
over side of OR bed
• Head-Up: (Reverse Trendelenburg/Semi-recumbent)
– Most safe
– Weight of abdominal contents unloaded from
diaphragm
– Use of well-padded footboard to prevent sliding
78. Ocular injuries
• The frequency of eye injury during anaesthesia
and surgery is very low (<0.1% of anaesthetics),
• As little as 10 min
• Corneal abrasions, periorbital,and conjunctival
edema, ocular hemorrhage,
• vitreous loss, retinal detachment,
• central retinal artery occlusion,
• ischemic optic neuropathy
79. Causes
• Patient movement,
• chemical irritation from prep solutions,
• direct trauma from face mask,
• pressure from the laryngoscopic blade,
• pressure effects on the globe from lateral
• and prone positioning, (duration )
• intraoperative hypotension, and anemia
81. Don’t Forget:
• Good positioning starts with an assessment
• Prevent surgical team members from leaning
• Arm board pads should be level with table pads
• Cushioning of all pressure points is a priority -
• Procedures longer than 2 ½ to 3 ??
• During a longer procedure, shifting the patient,
adjusting the table, or adding/removing a positioning
device
• assess extremities at regular intervals for signs of
circulatory compromise
• Documentation of the positioning process- accurate
and complete
82. Summary
• Change – check all
• Cardiac
• Respiratory
• Nerve injuries
• Pressure sores
• Visual loss
• Follow up for some days