Steep Trendelenburg positioning

 

List of problems:

Airway

·     Endobronchial intubation

·     Regurgitation -> aspiration upon flattening

·     Oedema -> CICO at extubation

Breathing

·     Alveolar collapse -> ↓oxygenation

·     Restrictive deficit -> ↓ventilation

          *Exacerbated in obesity*

Circulation

·     ↑CVP

Disability/neuro

·     ↑ICP -> oedema -> risk narcosis and respiratory depression

·     ↑IOP -> risk blindness

External

·     Sliding off the table

·     Brachial plexus injury

·     Compartment syndrome

·     Rhabdomyolysis

 

Post-op vision loss:

·        AION

·        PION

·        Retinal stroke

·        Cortical stroke

·        PRES

 

Risk factors for AION:

Patient

·      Male

·      Obese

Positioning

·      Prone

·      Wilson frame

·      Steep head down

·      Compressed eyes

Anaesthetic

·      Hypotension

·      Hypoxaemia

·      Anaemia

Surgery

·      Long duration

·      Blood loss

 

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