Lateral Decubitus
This position is often used for procedures requiring access to the thorax, retroperitoneal structures, hip, or shoulder. Flexion of dependent leg and hip helps keep alignment and stabilizes pt.
Padding between the legs and on the lateral aspect of the dependent leg protects the peroneal nerve.
Ensure the head is aligned with the spine to prevent occlusion of carotid/vertebral arteries, compromise of head perfusion, impairment of jugular venous drainage, and, thus, increased intracranial pressure (if drainage is blocked).
Proper arm support. The upper arm is elevated to prevent compression/stretch of the brachial plexus. Monitor pulse and capillary refill in dependent and nondependent arms to ensure sufficient circulation.
Neuromuscular blockers increase the risk of stretch injuries due to increased mobility of joints.
The ear is to be free, and a donut is to prevent the dependent eye from pressure (retinal artery stenosis, corneal abrasion). Tape the eyes before turning if the patient is asleep.
An axillary roll (IV fluid bag) is placed at the nipple level to prevent axillary artery and brachial plexus compression.
Kidney rest should lie under the dependent iliac crest.
Anesthetic considerations
- Favors overventilation of nondependent lung due to the lateral weight of the mediastinum and cephalad pressure of abdominal contents
- Blood flow follows gravity and goes preferentially to dependent lung tissue. This causes increased ventilation-to-perfusion mismatch and may affect gas exchange and ventilation
- Perfusion without ventilation = shunt
- Ventilation without blood flow/perfusion = dead space
Avoid hypotension to ensure proper tissue perfusion.
Length of procedure poses the most significant risk of injuries, including the above, Rhabdomyolysis, and renal failure.