A circulating nurse and anesthesia provider employed protective measures for a 68-year-old,ASA PS-2 female positioned in extreme 45-degree Trendelenburg for a robotic-assisted laparoscopic hysterectomy.These measures included :

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Accidental deployment of the remote can cause significant injury and death; therefore,the remote should be removed or locked.A vacuum-packed positioning device (i.e.,beanbag)that is approved for use in lithotomy position with steep Trendelenburg is used to prevent sliding while protecting the nerves of the brachial plexus.Another method is to place the patient directly on a gel overlay (without a sheet)to create a high friction coefficient and to counteract some of the effects of shear and pressure.Additionally,padded cross-chest straps secured to the bed after the arms have been padded and tucked at the sides can further secure the patient.

A Circulating Nurse and Anesthesia Provider Employed Protective Measures for a 68-Year-Old,ASA