ties in the past? Rarely, Trendelenburg has also been associated with
cases of retinal detachment and blindness. The pressure in the face
and behind the eyes can become severe. If patients have some degree
of retinal detachment or glaucoma, or some other ocular condition,
Trendelenburg may worsen it.
5. Beware of longer surgeries. When you keep a patient's head down
for a long time — longer than 3 or 4 hours — the patient ends up
receiving 3 or 4 liters of water, which in turn follows gravity and goes
into the patient's face, causing edema. That may cause airway difficul-
ties and a difficult extubation. These patients often end up having to
spend the night in an ICU.
6. Plan ahead with robotic cases. When complications develop during
other types of cases, you can lower the table. But during robotic
cases, you can't modify the position of the patient, so length of expo-
sure is even more crucial. If the case is going to be long, steep
Trendelenburg may be hazardous.
7. Know the math. Overall, complications that occur in steep
Trendelenburg are probably in the 1% to 2% range. So it can be
easy to dismiss or downplay the concern. But if you do a thousand
cases a year, 1% translates to 10 cases a year. And you certainly
7 6 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • M A R C H 2 0 1 6
Some surgeons have
the false notion that
steep Trendelenburg
is going to make a
difference with the
sigmoid, but it won't.
