Handbook of anæstheticsRoss, J. Stuart (John Stuart)
Science
Handbook of anæsthetics
Ross, J. Stuart (John Stuart)
Anesthesia; Anesthetics
The position in which the patient is lying is of as much importance to
the anæsthetist as to the surgeon. It is for the surgeon to say what
he wants and for the anæsthetist to realise how his own work will be
thereby affected.
Dorsal Decubities.
This is the ordinary position and calls for no extended comment. The
pillows must be so arranged that at no spot is the body acutely flexed
or extended. Abdomen, thorax, neck, and head must all be roughly in a
straight line.
Deep-chested subjects require a higher pillow than those with shallow
chests, otherwise the neck is bent back and respiration obstructed.
The arms should either be folded and retained by a bandage or other
device over the chest, or extended so that the hands can be slipped
under the buttocks and retained there by the body weight. An arm which
is allowed to hang over the side of the table is likely to show next
day and for many months afterwards, the condition of drop-wrist from
musculo-spiral paralysis.
Face-down Position.
This is an awkward position for the anæsthetist; there being a general
tendency to respiratory embarrassment. Put a pillow under the upper
part of the thorax, leaving the lower part and the abdomen as free as
possible. Let the head project from the pillow, so that the face can be
got at without undue rotation of the neck. The intratracheal method is
a great help.
Lateral Position.
This may be called for either with or without the addition of a
sand-bag or inflatable air-pillow to push the loin upwards. In either
case, there is a tendency for the upper shoulder to fall forwards, the
position then assimilating itself to the face-down position. This is
best met by a support fixed to the table, upon which the upper arm may
be rested. Failing such a convenience, a sand-bag may be pushed in to
keep up the shoulder, or the assistance of a nurse may be required.
The Trendelenburg Position.
Slight tilting of the head end of the table downwards is often useful
in assisting the return of bowel into the abdomen: in this position,
the patient usually takes the anæsthetic very well. It must not be
assumed until the third stage of anæsthesia is reached.
For many gynæcological operations, however, the full Trendelenburg
position is required. Healthy subjects usually do quite well in it, but
stout persons not uncommonly show a good deal of cyanosis. At the close
of the operation it is essential to restore the table to the horizontal
_slowly_: the physics of the circulation are profoundly modified,
and if any serious degree of shock is present, rapid return to normal
may initiate a collapse.
In the full position, the weight of the body should be taken by metal
supports attached to the table against which the shoulders may rest. To
hang the entire weight of the body upon the legs may cause a good deal
of after-suffering to the patient.
Public-domain text, read in full here on John Shaqi.
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