Patient Positioning: Physiologic Effects
Last updated: 07/18/2023
Authors
Niroop Ravula, MD, University of California Davis School of Medicine, Davis, CA
Caryn Zagaynov, MD, University of California Davis School of Medicine, Davis, CA
Key Points
The physiologic effects of each patient position are exaggerated in an
anesthetized patient since the compensatory mechanisms may be inhibited by
the anesthetic.
Positioning the patient is a shared responsibility among the anesthesiologist,
surgeon or proceduralist, and nurse in the operating room.
Introduction
Different patient positions may be required to provide access for different
surgeries and procedures. Each position will impact the patient physiology and
these can be exaggerated in an anesthetized patient since the compensatory
mechanisms may be inhibited by the anesthetic.1,2
Positioning the patient is a shared responsibility among the anesthesiologist,
surgeon or proceduralist, and nurse in the operating room.3
Common patient positions with their effects on hemodynamics, ventilation, and
other physiologic factors are discussed below.
Supine Position
The supine position is the most common position for surgical procedures with the
patient lying on their back with the head, neck, and spine in a neutral position, and
the arms either adducted alongside the patient or abducted to less than 90
degrees.1
Privacy - Terms
Figure 1. Supine position (Illustration by Sarah St.
Claire, RN, BSN, MS, CNOR)
Table 1. Physiological effects of the supine position
Trendelenburg Position
The Trendelenburg position is a variation of the supine position in which the head
of the bed is titled down at least 15 degrees.2
It is commonly used for intraabdominal pelvic surgeries, such as hysterectomy
and prostatectomy. It is also used temporarily during central line placement.3
Steep Trendelenburg position is often used during robotic surgery.
The Trendelenburg position has greater hemodynamic and respiratory effects
than the supine position.3 (Table 2)
Figure 2. Trendelenburg position (Illustration by
Sarah St. Claire, RN, BSN, MS, CNOR)
Table 2. Physiological effects of the Trendelenburg position
Reverse Trendelenburg Position
The reverse Trendelenburg position is a variation of the supine position in which
the head of the bed is titled upwards.
It is commonly used for upper abdominal surgeries, such as cholecystectomy or
gastric bypass to improve surgical exposure.
Figure 3. Reverse Trendelenburg position (Illustration
by Sarah St. Claire, RN, BSN, MS, CNOR)
Table 3. Physiological effects of the reverse Trendelenburg position
Prone Position
In the prone position, the patient is lying prone on their face and abdomen with
head, neck, and spine in a neutral position, and the arms are either adducted
alongside the patient or at a 90-degree angle at shoulders and elbows with
palms facing down.1-3
It is commonly used for spinal surgeries, posterior fossa craniotomies, rectal and
buttock surgeries, and superficial back procedures.
Figure 4. Prone position (Illustration by Sarah St.
Claire, RN, BSN, MS, CNOR)
Table 4. Physiological effects of the prone position
Lateral Position
In the lateral position, the patient is lying on their side with the operative side up.
The legs are slightly flexed. The down arm is padded and the upper arm is
supported on pillows or arm supports. A pad or roll should be placed under the
chest wall to alleviate pressure on neurovascular structures in the axilla.2,3
Importantly, the roll should not be in the axilla.
It is commonly used for hip, shoulder, and thoracic surgeries.
Figure 5. Lateral position (Illustration by Sarah St. Claire, RN,
BSN, MS, CNOR)
Table 5. Physiological effects of the lateral position
Lithotomy Position
The lithotomy position is a variation of the supine position, with the legs separated
and the hips and knees are flexed. The arms are either tucked in at sides or
abducted on arm boards.
It is commonly used for gynecologic, rectal, and urologic surgeries.
Figure 6. Lithotomy position (Illustration by Sarah St.
Claire, RN, BSN, MS, CNOR)
Table 6. Physiological effects of the lithotomy position
Sitting/Beach Chair Position
In the sitting or beach-chair position, the patient is on their back, the head of the
bed is raised, hips are flexed, and the legs are flexed at the knee.
It is commonly used for shoulder and posterior fossa craniotomies.
Figure 7. Sitting/beach chair position (Illustration
by Sarah St. Claire, RN, BSN, MS, CNOR)
Table 7. Physiological effects of the sitting/beach chair position
References
1. Armstrong M, Moore RA. Anatomy, Patient Positioning. In: StatPearls [Internet]. Treasure Island
(FL): StatPearls Publishing; 2023 Link
2. Hartley J, Baitch L. Patient positioning during anaesthesia. Anesthesia Tutorial of the week
(ATOTW). 2015 World Federation of Societies of Anesthesiologists. Link
3. Welch MB. Patient positioning for surgery and anesthesia in adults. In: Post T(ed). UpToDate.
2023. Link
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