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Positioning Children During Neurosurgery

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Fundamentals of Pediatric Neuroanesthesia

Abstract

Positioning refers to the body position in which a patient is placed for a surgical procedure. The optimal patient position should facilitate maximum surgical access with minimum physiologic perturbations or physical injury without compromising patient safety. The fundamental considerations about the position for neurosurgery aim to (a) provide the most acceptable access to the anatomical target, ensuring the comfort of the surgeon and patient and access to the anesthesiologist and adequate access for monitoring, (b) avoid brain retraction, (c) minimize intraoperative bleeding, (d) reduce intracranial pressure (ICP), (e) ensure adequate cerebral perfusion, (f) prevent compression or traction injuries (skin dehiscence, ocular injuries, peripheral nerve injuries), and (g) increase the likelihood of a successful surgery with a good outcome. The optimum positioning of children for neurosurgery poses unique challenges due to the anatomical and physiological differences and the age-wise variations in surgical lesions. Safe and comfortable positioning of the pediatric patient is of paramount importance. Knowledge, planning, and teamwork are the major components of attentive positioning, which fulfils the aim of the surgical procedure and prevents the ensuing complications, thereby reducing perioperative morbidity. This chapter describes the special considerations for positioning pediatric patients for the commonly performed neurosurgical procedures in commonly used positions (supine, lateral, prone, sitting) and their variations, how the position is established, associated complications, and measures to mitigate these complications.

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Author information

Authors and Affiliations

  1. Department of Neuroanaesthesiology and Critical Care, Neurosciences Centre, All India Institute of Medical Sciences (AIIMS), New Delhi, India

    Vanitha Rajagopalan & Girija Prasad Rath

  2. London Health Sciences Centre/St Joseph’s Hospital London/Windsor Regional Hospital, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada

    Sujoy Banik

Authors
  1. Vanitha Rajagopalan
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  2. Sujoy Banik
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  3. Girija Prasad Rath
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Editors and Affiliations

  1. Department of Neuroanesthesiology & Critical Care, All India Institute of Medical Sciences, New Delhi, Delhi, India

    Girija Prasad Rath

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Rajagopalan, V., Banik, S., Rath, G.P. (2021). Positioning Children During Neurosurgery. In: Rath, G.P. (eds) Fundamentals of Pediatric Neuroanesthesia. Springer, Singapore. https://doi.org/10.1007/978-981-16-3376-8_7

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  • DOI: https://doi.org/10.1007/978-981-16-3376-8_7

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  • Print ISBN: 978-981-16-3375-1

  • Online ISBN: 978-981-16-3376-8

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