A 68-year-old,American Society of Anesthesiologists (ASA)physical status (PS)-2 male with early-stage prostatic cancer,was intubated and positioned for a robotic-assisted laparoscopic radical prostatectomy.The initial position for insertion of the trocars was supine with arms tucked and secured within under-mattress sled arm positioners padded with gel.His hands were placed in a natural position with the fingers wrapped around gauze rolls and touching his lateral thighs.The new anesthesia provider,who had never seen a robotic prostatectomy,was concerned about anesthesia implications when the patient would be repositioned into extreme Trendelenburg for the dissection and anastomosis.The circulating nurse assured her that they would implement protective measures and work together to ensure the best patient outcome.Select all of the potentially harmful effects of extreme 45-degree Trendelenburg in a robotic procedure.

Question

Quizplus · Accepted Answer

Positioning can compromise the respiratory system.In almost all types of positions,except semi-Fowler,sitting,and reverse Trendelenburg,the abdominal viscera shift upward toward the diaphragm.Subsequently,the diaphragm shifts upward and outward such that it contributes only about two-thirds of the ventilatory force and significantly reduces tidal volume.Although the head-down position facilitates drainage of secretions from the bases of the lungs and the oropharyngeal passages,the weight of the abdominal viscera further impedes diaphragmatic movement; as abdominal viscera push the diaphragm up and compress the lung bases,pulmonary compliance and tidal volume diminish.Fluid shifts into the alveoli,causing edema,congestion,and atelectasis.Shearing is a significant risk in this position.The skeletal structure slides up toward the head of the bed.If the patient is draped,lifting the patient to realign the tissue cannot be done.

A 68-Year-Old,American Society of Anesthesiologists (ASA)physical Status (PS)-2 Male with Early-Stage