1. POSITIONING OF PATIENTS IN PERINEAL SURGERYBy
RANGANATHAN D

2. LITHOTOMY POSITION Lithotomy Position
The patient lies supine on the operating table.
The thighs and knees are flexed and supported
on stirrups . Additional padding should
be placed under the posterior compartment muscles
of the legs to reduce the risk of pressure ulceration.

3. SAFETY PRECAUTIONS The legs are secured onto the stirrups
with crepe bandaging. This position is routinely
used for cystoscopy, as it provides good exposure
of the perineum.
Both the legs must elevated simultaneously by two peoples .
Rising both legs at the same time keeps the body in the alignment and prevents twisting of lumbar spine.
Both the arms are tucked at the sides of the body & care must be taken to ensure that patient fingers do not become impinged as lower table portion is flexed or raised.

4. When the legs are placed in the stirrups the knee must be flexed first keeping them in the middle position, then the thigh’s are abducted while the knees are flexed after anaesthesiologists gives permission. Secure the compression area joints with cotton pads, use the soft bandages or belts to secure the legs. The side edge of the both hands must be secured and kept abducted within 90degree.

5. Complications
Nerve compression like popiteal nerve, femoral nerve, ulnar nerve& radial nerve.
Damage of achilles tendons.
Post operative discomfort to the patient.

8. JACKKNIFE POSITION It’s a modification of prone position.
General safety measures for Kraske (jackknife) position:
(1) All general safety measures for the prone position apply to the Kraske position.
(2) The hip joints should be over the middle break of the OR table.
(3) The head should be turned towards the non-affected or nonoperative side.

9. Acheivements of position
(4) The OR table should be moved into the Kraske position slowly. The patient should be closely observed to ensure the body maintains position, and the hip joints remain over the middle break.
(5) The safety strap should not be placed until after the position has been achieved. If the safety strap is placed prior to positioning, such as during movement of the OR table, the safety strap could cause shearing and friction injuries. The safety strap should be placed above the knees.
(6) The patient should be returned to the horizontal prone position as soon as possible.

10. Spine must be kept in a neutral position during the positioning.
SAFETY PRECAUTIONS
Spine must be kept in a neutral position during the positioning.
A sufficient clearance must be allow deep lung inflation.
In female patient the breast must be protected.
Forcing the breast laterally during position can cause bleeding & tearing of deep tissue at the margins.

11. Corneal abrasion causes blindness.
COMPLICATIONS
Damage of subclavian & brachial plexus causes thoracic outlet syndrome, risk of sever injury to the cervical spine.
Corneal abrasion causes blindness.

14. PRONE POSITION INDICATIONS
This position is mainly used to allow access to spine, cranium& perineal regions.
Prone Position
The patient is placed flat, face downwards on
the operating table, with their arms at their side.The face is supported with a head ring and the endotracheal tube position is safely secured.
This position may be used for closure of
myelomeningocele and excision of sacrococcygeal
teratoma.

15. POSITIONING OF PATIENTS
Align the stretcher with the operating table
Perform the catheterization and secure it, before positioning the patient.
Before positioning inform to anaesthesiologists, (by way they secure the IV lines. Disconnect the patient ventillation circuit temporarily).
Head is hold by anaesthesia care provider, two peoples are ready to receive the patient to the OT table.
One people hold the patient legs.

16. The hand must be abducted 90degree /less than 90 degree.
Contd.,
Keep cotton pads in eyes, elbow joints,ankles, knees, male genital area.
Keep a chest roll at the edge of 10th intercoastal rib.and a axillary roll.
Keep a gel pad or roll at the level of iliac spines, leaving abdomen free.
The hand must be abducted 90degree /less than 90 degree.

17. COMPLICATIONS Postoperative discomfort to the patient.
Damage of popiteal nerve, radial& ulnar nerve, brachial plexus.
Post operative pain to the patient.
Damage of cervical spine.
Discomfort to the patient.
Uneasy to handled by anaesthesia care provider.
Chances of airway obstruction.

18. Complication of prone position
Unintentional extubation
Eye complications: corneal abrasions, conjunctival and periorbital
edema of the dependent eye, retinal ischemia, post-operative
lymphatic obstruction).
Macroglossia.
Possibility of venous air embolism

19. Complication of prone position
visual loss due to ischemic optic neuropathy.
Entangling of cables.
Abdominal compression (leading to impaired ventilation, increased
bleeding, and decreased cardiac output).
Improper head and neck positioning (leading to venous and

21. Needful for Positioning
Minimum 4 members without anaesthesiologists
Proper and instruction must be discused by technologists with chief surgeons and anaesthesiologists
Follow each and every steps by the technologist

22. The End