anatomically correct. Anesthesia goes first to make sure everything is
in position (Is the vent good? Are the eyes good?) because you can't
proceed to the next step if the airway isn't secured. Once anesthesia
does its thing, our RN and RNA will check the head to ensure that it's
properly positioned and safe for the patient to remain in for up to sev-
eral hours. We follow the same anesthesia-nursing 1-2 check for each
of the patient's remaining pressure points — the neck, shoulders,
arms, chest, hips and knees and, finally, the feet. Once we get through
the initial check and make any glaring adjustments (left arm notice-
ably different than the right, for example), we start our final checklist.
Again, we do this from the same spot in the very same way with each
patient.
From the foot of the bed, everybody (nurses, doctors, anesthesia,
techs) will do one last check — this time from feet to head — to make
sure the patient is properly positioned. As we move up, our team will
look to answer questions like Are the hips level or is one slightly tilt-
ed? Is the spine perfectly straight? Is one shoulder higher than the
other? Are the elbows at the same level? Not every variation is the
result of poor positioning. Sometimes patients have certain anatomical
abnormalities that make it appear as if they're misaligned. But this
final checklist ensures no mistakes are made on our end. When we're
satisfied everything is where it should be, the surgeon gives the final
approval on the positioning.
An extra layer
Sometimes even the most methodical manual positioning isn't
enough. That's why we'll often add intraoperative neuromonitoring —
a way to monitor the case via the spinal cord using EEG needle elec-
trodes to stimulate the various pressure points throughout the body,
and uncover and correct any positioning errors in real time — to the
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