ABSTRACT
Figure 3.7. Sources of injury to the brachial plexus in a pronated patient. A, Head position stretching plexus against its anchors in the shoulder; B, potential closure of retroclavicular space by malpositioned chest supports when arms at side and neurovascular bundle trapped against first rib; C, head of humerus pushed into neurovascular bundle if arm and axilla not relaxed; D, compression of ulnar nerve at elbow; E, radial nerve at risk of external compression. (Adapted from Martin JT, Warner MA. Positioning in Anesthesia and Surgery, 3rd edn. Philadelphia: Saunders, 1997.)
inexact term in general use, used to describe the patient lying supine with the thighs abducted and legs raised, for operations on the genitals, urinary tract, anus, rectum, and perineum. Typical positions are shown in Figure 3.8 and each may involve a head-down tilt at some stage. It is important at the preoperative visit to know what position is intended and to ensure that the patient can adopt it. Check on symptoms of regurgitation. Ask specifically about a history of backache, sciatica, and any other neural symptoms in the lower limbs and document them.
