ABSTRACT
Proper positioning of the geriatric patient for neurosurgery is an important task for both surgeon and anesthesiologist. Surgical preference for positioning to access the anatomic target often represents a challenge in an anesthetized, and often paralyzed geriatric patient. This chapter describes commonly used positions during neurosurgical procedures, their benefits and risks, and preventive measures to minimize position-related complications in geriatric patients. Positioning of neurosurgical patients is a complex process, requiring adequate anesthetic depth, maintenance of hemodynamic stability and appropriate oxygenation as well as preservation of monitoring, especially invasive. The most common positioning-related complications include pressure sores and peripheral nerve injury. Development of peripheral nerve injury is associated with patient's age, diabetes, extremes of weight, alcohol and tobacco use, vascular disease, pre-existing paresthesias, and length of surgery. Intraoperative patient positioning should be carefully documented. Complications in neurosurgery-related positioning include visual loss, venous and paradoxical air embolism, cerebral edema, intracranial bleeding, pneumocephalus, quadriplegia, and macroglossia.
