Surgical Visualization_Layout 1 12/20/13 9:03 AM Page 29
S U R G I C A L
A C C E S S
reduces complication risks associated with lengthier procedures.
Surgical teams sometimes settle for "good enough" when positioning patients.
"If it's a straightforward case, that probably won't matter," says Dr. Crabtree.
"But what if the procedure turns out to be a difficult one, as invariably happens?"
For example, consider what Dr. Crabtree sees as one of the biggest positioning challenges in the outpatient arena (followed, in his mind, by lithotomy for
various GYN and urology procedures): the beach chair or lateral position for
shoulder surgery.
Positioning patients for shoulder surgery is challenging because the surgeon
operates in a tight space next to the patient's head and airway. "When you combine unnatural positions, limited surgical access space and concurrent comorbidities, risks don't become additive, they multiply," says Dr. Crabtree.
So what if the surgical team didn't focus on positing the patient properly?
"Now the surgeon is dealing with a labral tear and has to get way down to the
subcapsular zone," says Dr. Crabtree, "and would really appreciate having the
patient turned a little more into the lateral position or slightly more upright in
the beach."
But the patient's draped, and the surgical team groans at the hassle of adjusting the patient mid-procedure. "So they don't do anything," says Dr. Crabtree.
"Now the surgery lasts an additional hour because the surgeon struggles to
access the joint."
That's an important lesson: "Don't settle for inadequate positioning on the
front end," says Dr. Crabtree. "It will probably work out, but it might not," he
adds. "Commit to making positioning better, before every procedure."
Individual challenges
Everyone, including surgeons and anesthesia providers, must be actively involved
in positioning patients — standing in the room while checking paperwork doesn't
count. "Having more people involved increases the likelihood that the team won't
J A N U A R Y 2014 | S U P P L E M E N T
TO
O U T PAT I E N T S U R G E R Y M A G A Z I N E O N L I N E
2 9
