Intraoperative Patient Positioning and Neurological Injuries

  • Cara Reimer
  • Peter Slinger


Thoracic cases usually involve repositioning the patient after induction of anesthesia. Vigilance is required to avoid major displacement of airway devices, lines, and monitors during and after position changes. Obtaining central venous access after changing to the lateral position is extremely difficult. If a central line may be needed it should be placed at induction. Prevention of peripheral nerve injuries in the lateral position requires a survey of the patient from the head and sides of the operating table prior to draping. Postthoracotomy paraplegia is primarily a surgical complication.


Lateral Position Brachial Plexus Epidural Hematoma Spinal Cord Ischemia Lateral Flexion 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1.  1.
    Desiderio DP, Burt M, Kolver AC, et al. The effects of endobronchial cuff inflation on double-lumen endobronchial tube movement after lateral positioning. J Cardiothorac Vasc Anesth. 1997;11:595–9.PubMedCrossRefGoogle Scholar
  2.  2.
    Fortier G, Coté D, Bergeron C, et al. New land marks improve the positioning of the left Broncho-Cath double-lumen tube: comparison with the classic technique. Can J Anaesth. 2001;48:790–5.PubMedCrossRefGoogle Scholar
  3.  3.
    Britt BA, Gordon RA. Peripheral nerve injuries associated with anaesthesia. Can Anaesth Soc J. 1964;11:514.PubMedCrossRefGoogle Scholar
  4.  4.
    Lawson NW. The lateral decubitus position. In: Marton JT, editor. Positioning in anesthesia and surgery. 2nd ed. Philadelphia: WB Saunders; 1987. p. 175.Google Scholar
  5.  5.
    Yokoyama M, Ueda W, Hirakawa M. Haemodynamic effects of the lateral decubitus position and the kidney rest lateral decubitus position during anaesthesia. Br J Anaesth. 2000;84:753–7.PubMedGoogle Scholar
  6.  6.
    Attar S. Paraplegia after thoracotomy: report of five cases and review of the literature. Ann Thorac Surg. 1995;59:1410–6.PubMedCrossRefGoogle Scholar
  7.  7.
    Horlocker T. Regional anesthesia in the anticoagulated patient: defining the risks (the second ASRA consensus conference on neuraxial anesthesia and anticoagulation). Reg Anesth Pain Med. 2003;28:172–97.PubMedGoogle Scholar
  8.  8.
    Kreppel D. Spinal hematoma: a literature survey with metaanalysis of 613 patients. Neurosurg Rev. 2003;26:1–49.PubMedCrossRefGoogle Scholar
  9.  9.
    Short H. Paraplegia associated with the use of oxidized cellulose in posterolateral thoracotomy incisions. Ann Thorac Surg. 1990;50:288–90.PubMedCrossRefGoogle Scholar
  10. 10.
    Greenberg R. Contemporary analysis of descending thoracic and thoracoabdominal aneurysm repair: a comparison of endovascular and open techniques. Circulation. 2008;118:808–17.PubMedCrossRefGoogle Scholar
  11. 11.
    Shamji M. Circulation of the spinal cord: an important consideration for thoracic surgeons. Ann Thorac Surg. 2003;76:315–21.PubMedCrossRefGoogle Scholar
  12. 12.
    Newman NJ. Perioperative visual loss after nonocular surgeries. Am J Ophthalmol. 2008;145:604–10.PubMedCrossRefGoogle Scholar
  13. 13.
    Heitz JW, Audu PB. Asymmetric postoperative visual loss after spine surgery in the lateral decubitus position. Br J Anaesth. 2008;101:380–2.PubMedCrossRefGoogle Scholar
  14. 14.
    Cascio BM, Buchowski JM, Frassica FJ. Well-limb compartment syndrome after prolonged lateral decubitus positioning. J Bone Joint Surg. 2004;86:2038–40.PubMedGoogle Scholar
  15. 15.
    Aschemann D. Positioning techniques in surgical applications. New York: Springer; 2006.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Cara Reimer
    • 1
  • Peter Slinger
    • 2
  1. 1.Department of Anesthesiology and Perioperative MedicineKingston General HospitalKingstonCanada
  2. 2.Department of AnesthesiaToronto General HospitalTorontoCanada

Personalised recommendations