Tiffany Tran

ISM- Period 1

Dean, Elizabeth. "Effect of Body Position on Pulmonary Function." Research Gate.

Researchgate.net, June 1985. Web. 25 Mar. 2017.

<https://www.researchgate.net/publication/19169748_Effect_of_Body_Position_on_Pul

monary_Function>.

Ventilation and perfusion matching and gas exchange can be theoretically augmented in
the supine position by an increase in cardiac output. Base-to-apex ratios for the
distribution of ventilation and perfusion in the supine position have been reported to be
0.9 to 1 and 1.3 to 1, respectively. Pg. 615
The reduced FRC in the supine position tends to favor airway closure and decreased gas
exchange even in healthy subjects. Pg. 615
This effect is further potentiated in individuals who are older, overweight, or smoke and
whose FRCs tend to be below closing volume. Pg. 615
individual differences need to be considered when positioning patients because age,
weight, and smoking habits have an effect on airway closing volume and, hence, on
ventilation and V/Q matching. Pg. 615
The supine position has a negative effect on the pulmonary function and arterial blood
gas composition.
Arterial oxygen tensions were greater in the lateral position compared with the supine
position within each group studied. Pg. 615
Ascent of the diaphragm in the COAD patient during expiration is frequently restricted
by loss of lung elasticity and by the tendency of the less damaged portions of the lungs to
be hyperinflated. Pg. 617
Supplemental oxygen must be always administered cautiously to any patient. Pg. 615
Appropriate positioning may help to reduce the oxygen required by the patient and
maximize the efficacy of the prescribed dosage. Pg. 615
Such an approach to improving pulmonary oxygenation may provide good rationale for
keeping oxygen administration at minimal threshold levels and, thereby, avoid excesses
and possible untoward side effects of this drug. Pg. 615

This source is very informative about how the supine and lateral position affects lung function
and variables.
 Tiffany Tran
ISM- Period 1

Martin, John T., MD. "The Trendelenburg Position: A Review of Current Slants about Head
down Tilt." Journal of the American Association of Nurse Anesthetists 63.1 (1995): 29-36. Web.
22 March 2017.
In Trendelenburg, up to a liter of blood can be returned from the lower extremities
into the central circulation. Pg. 30
The initially increased cardiac output elevates hydrostatic pressure at baroreceptors
situated on the aortic arch and at the carotid bifurcation. Pg. 30
Reflexes initiated by those baroreceptors produce generalized vasodilation,
decreased stroke volume, reduced cardiac output and a decrease in organ perfusion.
Pg. 30
The sequence of symptoms is usually anxiety, restlessness, the onset of a pounding
vascular headache, nasal congestion that may force mouth breathing, progressive
dyspnea, loss of cooperation, sometimes overt hostility, and then usually struggling
efforts to sit upright. Pg. 30
Healthy patients will withstand considerable tilt during anesthesia and surgery, but
the presence of pulmonary, cardiovascular, and central nervous system disease can
make the posture harmful. Pg. 30
In 1968, Scott and colleagues reported from England that anesthesia administered
by mask to spontaneously ventilating patients produced no respiratory
embarrassment after almost an hour in steep (30 degrees) head down tilt. Pg. 30
Two decades later, however, Reich, studying well-instrumented patients, found that
3 minutes of shallow (20 degrees) head down tilt created evidence of right
ventricular stress and deteriorating pulmonary function while only minimally
increasing either cardiac output or mean arterial pressure. Pg. 31
They urged caution in the use of head down tilt in patients with pulmonary disease
or right ventricular compromise. Pg. 31
Head down tilt forces the diaphragm cephalad. While this may minimize the
respiratory fluctuations of viscera to and from the surgical field, it also threatens to
compact the bases of the lungs and limit their expansibility. Pg. 31
In the tilted lung, blood gravitates toward the poorly ventilated apex.
Ventilation/perfusion ratios in that area will be altered. Pg. 31
Increased intermittent positive pressure, used in an attempt to ventilate the
congested and poorly expansible apices, will first over distend more compliant lung
units, perhaps increasing alveolar pressures in those areas to levels that exceed
capillary pressures and compromise alveolar perfusion. Pg. 31
Causes an increase in venous congestion both inside and outside of the cranium.
Pg. 32

This source was very in depth about effects that the Trendelenburg position has on a patients
body and I find it very useful.
 Tiffany Tran
ISM- Period 1

Palmer, Laura. Surgical Positioning Website. University of Pittsburgh Nurse Anesthesia Program,

10 Sept. 2006. Web. 23 March 2017. <http://www.pitt.edu/~position/>.

Supine: The patient lies with his or her back on the table (face-up).
This is the most natural position for the body at rest.
Procedures of the anterior body such as: abdominal, thoracic, facial, anterior
upper and lower extremity procedures
A blanket or pillow may be placed under the knees to relieve lumbar strain, with
a small pillow or roll under the ankles, or egg crate under the heels, to relieve
any pressure from this area.
The head is positioned neutrally with c-spine alignment to prevent instability
and nerve damage. Careful attention is given to the back of the head, eyes, ears,
and nose to prevent compression injuries. Consider using a foam donut for
underneath of the head. The chin should be 2-3 fingerbreadths from the torso.
The patient is secured to the table with safety belt or wide 3 Inch Tape over a
pad, across the thighs, mid-thigh, to 2 inches above the knees. This is suitable
for upper torso, lower abdominal or groin surgery.
The arms are padded and positioned to prevent nerve stretch or compression.
Lateral: The patient is turned to rest on one side of his or her trunk, with the
dependent (down) side naming the position.
Surgical access to the hemithorax, kidney, retroperitoneal space, EGD's and
ERCP's among others.
Operating bed remains flat and patient is anesthetized and intubated in the
supine position, and the ETT is securely fastened.
In most cases, the lower leg is padded with egg crate and flexed at the knee to
prevent rolling and aid in stabilization.
At least 2 pillows are placed between the legs to aid in spinal alignment, and to
remove pressure from the lower leg and bony prominences (which can help
prevent circulatory compromise and injury to the peroneal nerve).
Additional padding is placed at the knees and under ankles to provide support,
and prevent nerve injuries and foot drop.
An axillary roll is placed to relieve pressure from the neurovascular
structures, preventing brachial plexus nerve injury, to preserve blood flow to the
dependent arm, and allow for better chest excursion.
Trendelenburg: A variation of supine, the patient is positioned supine, and then
the entire table is tilted in a head down aspect.
Procedures of the anterior body such as: laparoscopic surgery, abdominal,
gynecologic surgery

This source has detailed information like definitions of surgical positions, how to position
patients step by step, and recommended methods to prevent any kind of post-operative
complications.
 Tiffany Tran
ISM- Period 1

"Patient Positioning and Injury (Anesthesia Text). OpenAnesthesia. OpenAnesthesia, n.d. Web.

31 Mar. 2017.

<https://www.openanesthesia.org/patient_positioning_and_injury_anesthesia_text/>

In transitioning to the supine position, ventilation becomes a function of abdominal and

diaphragmatic movement, with less contribution from the rib cage / chest wall than when
upright.
Compared to other surgical positions, the supine position produces the least amount of
hemodynamic and ventilatory changes.
Complications of the supine position include pressure alopecia (for long procedures),
backache, and tissue ischemia
If a patient is placed in Trendelenburg position, shoulder braces should not be used as
the risk of compressive injury to the brachial plexus is significant.
Complications of the Trendelenburg position include increased intracranial and
intraocular pressure, as well as increased facial/laryngeal edema which can lead to post-
operative airway obstruction (consider using the air leak test in these patients). FRC and
pulmonary compliance are reduced by the dislocated viscera.
Lateral decubitus is associated with pulmonary compromise due to movement of
abdominal contents as well as the mediastinum, which enhance airway movement to the
non-dependent lung while increasing blood flow to the dependent lung, thereby adversely
affecting ventilation-perfusion matching
Placing someone in lateral decubitus may require additional support for the head.
The dependent eye should be checked for external compression and both eyes should be
taped prior to positioning.
A chest roll (NOT an axillary roll) is placed caudal to the axilla, ensuring that the
thorax is supported by the chest wall and not the actual axilla.
The dependent arm is perpendicular to the body consider checking pulses periodically
(lost pulse = arm compression vs. general hypotension).
A kidney rest placed under the dependent iliac crest and prevent compression of the
vena cava.

This source was useful for major effects that my focused position cause during surgery and
included some of the most common complications of each position.