Patient Positioning in Thoracic Surgery

Abstract

Positioning of a patient plays an important role in all surgical procedures. Good dissection and manipulation are possible only with adequate exposure of the surgical field. This in turn can be easily attained with appropriate adjustment of the operating table and use of accessories like hand support. Various positions have been described for thoracic surgeries, but none of these positions are free of complications. The complications may vary from mild to life-threatening haemodynamic changes. The surgeon and anaesthesiologist must be aware about the required body positions for a specific type of surgery. Prior to final positioning, all the necessary precautions must be taken. Once the surgery has started, it is difficult to manipulate or change the patient position. Though most of the thoracic surgical procedures are conducted in lateral position, some procedures are conducted in other positions as well. There are some universal precautions which must be practiced in all positions, e.g. eye care, padding of all bony prominences, avoidance of excess abduction and extension of limbs, neck and spine. Prophylactic precautions for deep vein thrombosis is another important measure, which must be considered prior to the surgery. If needed, low molecular weight heparin may be administered prior to the surgical procedure. In addition to this, specific care is required for some specific positions. Various commonly used patient positions in thoracic surgery are described below.