Positioning your patients

You have to deal with varieties of position when you anaesthesised your patients, it is mainly dependent on where the major organ involved would be. Patient positioning is important because your patient cannot complain of their discomfort during the procedure under anaesthetics, that discomfort may occur because of the entrapment of peripheral nerves in the weight bearing point, or even pain from the pressure after the position is secured. For examples, your patient can become blind because you have not appropriately protected their eyes in prone position. Even in supine position pressure sore due to inappropriate pillow may cause baldness >.<

The more important thing would be cardiopulmonary physiologic changes from patient positioning, cardiovascular and haemodynamic changes would be your major concern when you turn your patient's  position to prone, because if your have not protected the compression of both the chest and the abdomen, you will definitely get your patient hypotensive and load of bleeding because you have impeded the venous return to the heart especially the IVC. Not only the prone, but also the head up position or even the sitting position is the major cause of hypotension, because the patient's heart is higher than the legs and abdomen therefore you have to throughoutly look for any cause that might prevent venous drainage back to the heart.

You have to consider the change in lung compliance when you prepare your patient in the position suitable for surgical procedure, in supine, sitting the lung expansion would be improved, while in lateral position you have to think of mismatching of the perfusion and ventilation, because the upper lung (independent lung) would get more ventilation but less blood, while the other way round applies to dependent lung, because blood will behave like waterfall effect. In prone position the ventilation would be attenuated most if your have not supported the chest wall well enough. 

When you plan to put your patient in Lithotomy position, you can have better haemodynamics parameters because you promote venous return at first and then maintain a higher SVR by the raising legs, however, that is the start of the problem because you can have hypotensive episode by the end of the surgical procedure when you put your patient's legs back to supine position. Be careful of this.