muscle breakdown. There have even been cases of rhabdomyolysis
caused by steep Trendelenburg. When muscle breaks down, protein
particles can damage kidneys and cause other potentially life-threat-
ening problems. Fortunately, most now realize we need to use other
mechanisms to prevent sliding.
10. To prevent sliding, use devices that distribute force equally. The
best way to keep patients from sliding is to use an air pad or other
device that distributes force equally all over the body. The first
thing I do is place a 3-foot by 5-foot surgical sheet horizontally in
the middle of the table, corresponding to the patient's arm position.
I then put a layer of egg-crate foam on top of that, and make sure
it's securely taped to the table. Bean bag positioners, which mold to
the body, are also effective ways to prevent sliding, as are gel-type
mattresses that work like memory foam. Many commercial prod-
ucts are available. The key is to use something you don't have to
attach to the patient. Just having the patient lie down should do the
trick.
11. Protect the arms. Be sure to tuck the patient's arms with sheets or
arm sleds. If you put them in arm boards and the patient slides, that
can put a lot of pressure on the brachial plexus and lead to neuromus-
cular injuries. Well-padded arm sleds made of rigid plastic material
can help protect and stabilize the arms of obese patients.
12. Don't forget the patient's face. Often there's a drape over the
patient's face, and nobody's checking the face. But it can be an
important consideration. If, say, the procedure has entered its third
hour, you may see ballooning (edema) in the face, and that should
be a cue to stop the case or reverse the Trendelenburg before the
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