Ask if the patient is comfortable before you put them to sleep

Be happy with position before the drapes go up 

FRC decreases 800mL

Have decreased recoil and decrease lung volumes 

Arms tucked with thumbs up and IV wrapped

Arms out less than 90 degreers

Increases ICP, PIP, increased BP from preload 

Decrease TV (sometimes HR decrease) 

Brachial plexus could be smushed- sometimes use sholder pads

Clavicles to iliac crest 

Do not turn head- obstructs jugular venous return 

Protect face parts

Risk for ION 

Arms tucked or less 90 degrees 

Causes post-op visual loss

Risk from prolonged hypotension, anemia, or hemodilution 

axillary roll, neutral head, dependent ear flat, flexed depedent leg, check dependent eye

Down arm should have pulse ox and art line

Beware of too much head flexion

Risk of VAE

Decreased CO, CPP, BP

Need TEDs 

venous air embolus

Characterized by a wheel mill mumur

Use CVP to aspirate air embolus out 

Use a Doppler?

Most common lower extremtity nerve injury

common in lithotomy 

Increased PIP, CO, CVP, PAP, POP

Decreased perfusion to legs

WATCH OUT FOR COMMON PERONEAL NERVE 

Elevate legs at same time- can have HOTN as legs come down 

Can increase HNP pain in lower back

Most common peripheral nerve injury

Causes an inability to abduct or oppose 5th finger:claw hand 

Damaged by IV pokes in AC fossa or extravasation

Inability to oppose 1st and 5th digit 

Wrist drop

Frequent BP ycles 

Also weak abduction of thumb 

2nd common post-op nerve injury

Head/neck stretched, or greater than 90 degrees

Compressed by clavicle with shoulder braces

Sternal retraction 

Injury from stretching in lithotomy

Can also be damaged by IM injections