Skip to main content

Comorbidities and Positioning: Morbid Obesity and Multiple Trauma

  • Chapter
  • First Online:
  • 766 Accesses

Abstract

Neurosurgical positioning is challenging even in a controlled environment. Comorbidities such as morbid obesity and polytrauma make operative positioning even more challenging. Prone positioning requires extra thought and preparation, especially in the obese patient. Extensive preoperative workup may be required. Intra-abdominal pressure should be minimized. Great care must be taken when positioning to avoid peripheral nerve injury, pressure points sores, and ischemic optic neuropathy. Positioning of the polytrauma patient is equally challenging and requires cooperation between the anesthesia team and multiple surgical teams in time-pressured emergency situations. Protection of the spine during intubation and positioning is key.

This is a preview of subscription content, log in via an institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Ecklund JM, Moores LE, editors. Neurotrauma management for the severely injured polytrauma patient. New York: Springer; 2017.

    Google Scholar 

  2. Melio FR. Priorities in the multiple trauma patient. Emerg Med Clin North Am. 1998;16:29–43.

    Article  CAS  PubMed  Google Scholar 

  3. Wisner DH, Victor NS, Holcroft JW. Priorities in the management of multiple trauma: intracranial versus intra-abdominal injury. J Trauma. 1993;35(2):271–6.

    Article  CAS  PubMed  Google Scholar 

  4. Hernandez AM, Roguski M, Qiu RS, Shepard MJ, Riesenburger RI. Surgeons’ perspectives on optimal patient positioning during simultaneous cranial procedures and exploratory laparotomy. South Med J. 2013;106(12):679–83. https://doi.org/10.1097/SMJ.0000000000000030.

    Article  PubMed  Google Scholar 

  5. Panczykowski DM, Tomycz ND, Okonkwo DO. Comparative effectiveness of using computed tomography alone to exclude cervical spine injuries in obtunded or intubated patients: meta-analysis of 14,327 patients with blunt trauma. J Neurosurg. 2011;115(3):541–9. https://doi.org/10.3171/2011.4.JNS101672. Epub 2011 May 27.

    Article  PubMed  Google Scholar 

  6. Eggstein S, Franke M, Hofmeister A, Rückauer KD. Postoperative peripheral neuropathies in general surgery. Zentralbl Chir. 2000;125(5):459–63.

    CAS  PubMed  Google Scholar 

  7. Agostini J, Goasguen N, Mosnier H. Patient positioning in laparoscopic surgery: tricks and tips. J Visc Surg. 2010;147(4):e227–32. https://doi.org/10.1016/j.jviscsurg.2010.07.010.

    Article  CAS  PubMed  Google Scholar 

  8. Bray GA. Pathophysiology of obesity. Am J Clin Nutr. 1992;55(2Suppl):488S–94S.

    Article  CAS  PubMed  Google Scholar 

  9. Biring MS, Lewis MI, Liu JT, Mohsenifar Z. Pulmonary physiologic changes of morbid obesity. Am J Med Sci. 1999;318(5):293–7.

    Article  CAS  PubMed  Google Scholar 

  10. Maxwell MH, Waks AU, Schroth PC, Karam M, Dornfeld LP. Error in blood-pressure measurement due to incorrect cuff size in obese patients. Lancet. 1982;2:33–6.

    Article  CAS  PubMed  Google Scholar 

  11. Ide P, Farber ES, Lautz D. Perioperative nursing care of the bariatric surgical patient. AORN J. 2008;88(1):30–54.

    Article  PubMed  Google Scholar 

  12. Pearce DJ. The role of posture in laminectomy. Proc R Soc Med. 1957;50(2):109–12. PubMed PMID: 13408221; PubMed Central PMCID: PMC1888995.

    CAS  PubMed  PubMed Central  Google Scholar 

  13. Palmon SC, Kirsch JR, Depper JA, Toung TJ. The effect of the prone position on pulmonary mechanics is frame-dependent. Anesth Analg. 1998;87(5):1175–80.

    CAS  PubMed  Google Scholar 

  14. Wu SD, Yilmaz M, Tamul PC, Meeks JJ, Nadler RB. Awake endotracheal intubation and prone patient self-positioning: anesthetic and positioning considerations during percutaneous nephrolithotomy in obese patients. J Endourol. 2009;23(10):1599–602. https://doi.org/10.1089/end.2009.1524.

    Article  PubMed  Google Scholar 

  15. Douglass J, Fraser J, Andrzejowski J. Awake intubation and awake prone positioning of a morbidly obese patient for lumbar spine surgery. Anaesthesia. 2014;69(2):166–9. https://doi.org/10.1111/anae.12387. Epub 2013 Sep 23.

    Article  CAS  PubMed  Google Scholar 

  16. Brodsky JB. Positioning the morbidly obese patient for anesthesia. Obes Surg. 2002;12(6):751–8.

    Article  PubMed  Google Scholar 

  17. Postoperative Visual Loss Study Group. Risk factors associated with ischemic optic neuropathy after spinal fusion surgery. Anesthesiology. 2012;116(1):15–24. https://doi.org/10.1097/ALN.0b013e31823d012a.

    Google Scholar 

Download references

Conflict of Interest

The authors declare no conflict of interest.

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Sieg, E.P., Timmons, S.D. (2018). Comorbidities and Positioning: Morbid Obesity and Multiple Trauma. In: Arthur, A., Foley, K., Hamm, C. (eds) Perioperative Considerations and Positioning for Neurosurgical Procedures. Springer, Cham. https://doi.org/10.1007/978-3-319-72679-3_17

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-72679-3_17

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-72678-6

  • Online ISBN: 978-3-319-72679-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics