As a common masked warrior in the hospital-anesthesiologist, every time he is busy in the dark, when he is ready to sit down and rest after surgery, he will always hear the word' pose' in despair.
supine position
The supine position is a very common position, and it is also my favorite position for patients during surgery, of course, because I don't have to do it.
Supine position is common in thyroid and breast surgery, as well as otolaryngology, stomatology and plastic surgery, which has relatively little impact on physiology.
Common physiological changes: diaphragmatic bulge, increased cardiac blood volume and abnormal cardiopulmonary function may all lead to or aggravate heart failure and dyspnea.
On the basis of supine position, in fact, many positions can be evolved, such as head high position, head low foot high position (Trenberg position), gallbladder position, thyroid position, beach chair position, herringbone position and so on.
Here, I mainly mention Trenberg's position. In this position, the abdominal organs are squeezed to the head side, which makes the chest pressure increase, the lung compliance decrease, the functional residual capacity decrease, the central venous pressure increase, the intracranial pressure increase, the left heart and right heart preload increase, and the systemic vascular resistance decrease.
However, the high head position makes the abdominal organs move down relatively, the lung compliance increases and the functional residual capacity increases. The return blood volume decreases, the head arterial pressure decreases, and venous return is relatively easy.
Interceptor position
It is common in perineal surgery, such as gynecological surgery from vagina, urological surgery through urethra, gastrointestinal surgery through anus, etc. The lithotomy position is mostly because it is convenient to expose the surgical field of vision and easy to operate.
This posture will reduce the blood flow of lower limbs and increase the blood flow back to the heart. Therefore, for the elderly and patients with circulatory deviation, it is necessary to pay attention not to put both lower limbs in supine position at the same time, and to slowly release one leg to reduce the impact on blood pressure and heart rate of patients.
The correct way is to put a lower limb flat first, and then measure blood pressure. If the fluctuation is not big, you can continue to lower your opponent. If the fluctuation is large, it is necessary to measure the blood pressure after an interval of 5- 10 minutes to determine whether the other lower limb can be flattened.
lateral position
It is common in thoracic surgery and kidney-related surgery.
When lying on your side, the proportion of ventilation blood flow will be unbalanced due to gravity. It is necessary to detect the changes of carbon dioxide and tidal volume at the end of respiration and adjust the ventilator parameters in time.
Long-term compression of lower limbs is easy to cause ischemia. The intraocular pressure in the lower eye is elevated, so pay attention to protecting the eyes. However, these nurses and sisters will do it. We mainly pay attention to whether there is any phenomenon such as tracheal tube folding and falling off during the operation.
prone position
Commonly used in cervical and lumbar surgery, but also in other operations, as well as hemorrhoidectomy in anorectal department.
Of course, percutaneous nephrolithotomy has lateral position and prone position, which is undoubtedly my most annoying position. I believe everyone is similar to me. Every time I feel very tired, I don't say anything, but I'm always worried about twisting the patient's neck and worrying that the patient's tracheal tube will come out. Anyway, it really hurts my heart.
In prone position, due to the limitation of chest movement, lung compliance is obviously reduced, airway pressure is increased, and of course, intraocular pressure is also increased.
Finally, attach posture placement skills:
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