Kraske or jackknife position

IntroductionIn this variation of the disposed topographic point, the endurings head and feet ar both lower than the hips. The darn prod stake is intentiond nigh frequently for proctologic procedures. It is also the gold standard in anorectal surgical procedures (Kneedler & Dodge, 1994).PositioningThe forbearing is either anesthetized supine and turned prone, or is placed in perplex before spinal anesthetic is administered. The hips argon on a pillow or towel directly all over the table break and the table is flexed 90, with the head and legs down. The patients arms are on arm boards with hands toward the head. The buttocks whitethorn be separated by wide tape placed at the level of the anus on both sides and secured to the table. The patient is taken out of the position by first flattening the table and then reversing the order of endeavours into the prone position. ordnance are usually positioned over the head for turning (Bailey & Snyder, 2000).Anesthesia FactorsOne of the approximately honey oil concerns about the prone jack jab position is the safety of the flight path during anesthesia. Patients are occasionally placed in lithotomy position rather than the like prone jack clapper position because of the concern for the airway. While patient safety is a prime concern, there are no reports of the exit of control of airway during re arrangement. Although this lack of evidence does not exclude idiosyncratic episodes, it does indicate that the heightened awareness has probably minimized the risk to the patient to an grateful level (Jaffe & Samuels, 2004).Patient FactorsIndividual physical limitations of the patients occasionally prevent the use of the jack knife position. Physical factors that would prevent a patient from lying prone on the direct table, such as obesity, pregnancy, and tense ascites, may require the use of a different position. Orthopedic considerations, such as hip and human knee joint problems, long leg casts, and kyph osis may be contraindications to this position. In these relatively rare circumstances, consideration should be given to the lateral position.Perhaps the unmarried most important patient factor is the shape of the buttocks (or learning of the gluteal offer). It was found to be an important factor in determine the patient position and type of anesthesia to be used in the procedure (Spry, 1997).Surgeon FactorsThe primary reason that many surgeons prefer the prone jack knife position is the excellent visibility provided during anorectal procedures. The exposure provided for situation procedures, such as excision of thrombosed external hemorrhoids or drainpipe of abscesses is not equaled by other positions. In the operating room, whether the surgeon is dissecting the rectum sullen of the prostate or vagina in an abdominoperineal resection or preserving the internal sphincter during a mucosectomy for ulcerative colitis, visibility and lighting are key factors. Since the gluteal clef t is in horizontal rather than a vertical orientation in the prone jack knife position, illumination can be provided with strike lights rather than headlamps. Similarly, to a greater extent than one person can visualize the operating field without crowding or being in an awkward torso position (Bailey & Snyder, 2000).Physiologic FactorsThe jack knife position has been described as the most precarious of surgical positions. Both respiration and circulation can be most adversely affected. Vital capacity is reduced due to restricted diaphragmatic movement and increased blood volume in the lungs, reducing lung compliance (Kneedler & Dodge, 1994).Careful positioning of patients when they are under anesthesia is crucial. Most surgeons focus on the avoiding slander to peripheral nerves from prolonged pressure when positioning patients. However, an even more significant risk to overall patient well-being can extend from the unintended consequences of anesthesia that may affect patient p hysiology. They include compressing of arteries, impairment of venous return, limitation of ventilation, and blood pooling. Many authors have examined the prone jack knife position to assess the potential physiologic impact.There are mixed reports about the cardiac make of the prone jack knife position. If the patient is improperly positioned, transmitted pressure on the vena cava may cause blood pooling in the lower extremities and result in assortment magnitude venous return. In one study, when patients were turned from the supine to the prone position there was a temporary reduction in cardiac list 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 systemic vascular resistance with change from the supine position to the prone jack-knife position, but there was a decrease in the left ventricular stroke work index and a signif icant increase in the pneumonic capillary wedge pressure. Overall, the effects of the jack knife position were comparable to other surgical positions and were believed to be manageable by experienced anesthesiologists.The effect of posture on pulmonary physiology in customary and the specific effect of the prone jack knife position on vital capacity have been examined. When patients in the sit positing are considered to be baseline, there is a 9% decrease in vital 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 due 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 conscious sedation and general anesthesia (Bailey & Snyder, 2000).ReferencesBailey, H. R., & Snyder, M. J. (2000). Ambulatory Anorectal Su rgery. crude 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 Nursing (2nd ed.). Gaithersburg, Maryland Jones and Bartlett Publishers.