Kraske or jackknife position

IntroductionIn this variation of the inclined linear perspective, the patients head and feet ar some(prenominal) lower than the hips. The rogue tongue location is used around frequently for proctologic social functions. It is alike the gold standard in anorectal surgical procedures (Kneedler & Dodge, 1994).PositioningThe patient is either anesthetized unresisting and move flat, or is dictated in perspective before spinal anesthetic agent is administered. The hips be on a repose or towel directly all over the table break and the table is flexed 90, with the head and legs down. The patients blazon be on arm boards with manpower toward the head. The female genital organ may be separated by wide tape put at the level of the anus on both sides and secured to the table. The patient is taken out of the spotlight by first flattening the table and past reversing the order of causal agencys into the given puzzle. Arms are usually positioned over the head for play (Bailey & Snyder, 2000).Anesthesia FactorsOne of the near common concerns about the habituated jack knife position is the safe of the respiratory tract during anaesthesia. Patients are occasionally placed in lithotomy position preferably than the like prone jack knife position because of the concern for the airway. While patient base hit is a prime concern, in that location are no reports of the loss of control of airway during repositioning. Although this lack of evidence does not head off individual episodes, it does indicate that the heightened awareness has credibly minimized the risk to the patient to an unexceptionable level (Jaffe & Samuels, 2004).Patient FactorsIndividual physical demarcations of the patients occasionally impede the use of the jack knife position. corporeal factors that would prevent a patient from deceit prone on the operating table, such as obesity, pregnancy, and tense ascites, may use up the use of a different position. orthopedical con siderations, such as hip and genu joint problems, long leg casts, and kyphosis may be contraindications to this position. In these relatively rare circumstances, consideration should be devoted to the lateral position.Perhaps the single most meaning(a) patient factor is the shape of the buttocks (or depth of the gluteal c remaining). It was found to be an important factor in find out the patient position and type of anaesthesia to be used in the procedure (Spry, 1997).Surgeon FactorsThe primary reason that many surgeons opt the prone jack knife position is the excellent profile provided during anorectal procedures. The movie provided for office procedures, such as track of thrombosed external hemorrhoids or waste pipe of abscesses is not equaled by other positions. In the operating room, whether the surgeon is dissecting the rectum off of the prostate gland or vagina in an abdominoperineal resection or preserving the familiar sphincter during a mucosectomy for ulcerativ e colitis, visibility and lighting are key factors. Since the gluteal cleft is in horizontal or else than a vertical orientation in the prone jack knife position, igniter crumb be provided with overhead lights rather than headlamps. Similarly, more than one person can visualize the operating field without move or being in an embarrassing body position (Bailey & Snyder, 2000).Physiologic FactorsThe jack knife position has been described as the most precarious of surgical positions. Both internal respiration and circulation can be most adversely affected. Vital capacity is reduced repayable to restricted diaphragmatic movement and increased declension volume in the lungs, reducing lung ossification (Kneedler & Dodge, 1994).Careful positioning of patients when they are under anesthesia is crucial. Most surgeons focus on the avoiding reproach to peripheral nerves from prolonged embrace when positioning patients. However, an even more strong risk to overall patient well-bein g can result from the unintended consequences of anesthesia that may affect patient physiology. They embarrass compression of arteries, impairment of venous return, limitation of ventilation, and blood pooling. Many authors have examined the prone jack knife position to tax the potential physiologic impact.There are conglomerate reports about the cardiac personal effects of the prone jack knife position. If the patient is improperly positioned, transmitted pressure on the mineral vein cava may cause blood pooling in the lower extremities and result in decreased venous return. In one study, when patients were turned from the resupine to the prone position in that respect was a temporary decrease in cardiac ability however, when the patients were placed in the prone jack knife position the cardiac index returned to the level seen in the supine position.There was no change in heart rate, mean arterial pressure, and planetary vascular resistance with change from the supine pos ition to the prone jack-knife position, but there was a decrease in the left ventricular stroke work index and a significant increase in the pulmonary capillary wedge pressure. Overall, the effects of the jack knife position were alike(p) to other surgical positions and were believed to be pliant by experienced anesthesiologists.The effect of metier on pulmonary physiology in general and the specific effect of the prone jack knife position on alert capacity have been examined. When patients in the seated positing are considered to be baseline, there is a 9% decrease in rattling capacity in the supine position, a 12.5% decrease in the jack knife position, and an 18% decrease in the lithotomy position. The reduction in vital capacity is callable to obstruction of the movement of the diaphragm and to a lesser extent to the restriction of the anteroposterior movement of the ribs. This modest decrease is tolerated by most patients but merits careful monitoring during sure sedati on and general anesthesia (Bailey & Snyder, 2000).ReferencesBailey, H. R., & Snyder, M. J. (2000). ambulant Anorectal Surgery. New York Springer.Jaffe, R. A., & Samuels, S. I. (2004). Anesthesiologists Manual of surgical Procedures (3rd ed.). New York Lippincott Williams & Wilkins.Kneedler, J. A., & Dodge, G. H. (1994). Perioperative Patient Care The care for Perspective (3rd ed.). Sudbury, Massachusetts Jones and Bartlett Publishers.Spry, C. (1997). Essentials of Perioperative care for (2nd ed.). Gaithersburg, Maryland Jones and Bartlett Publishers.