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Discussion

lithotomy before induction?

I have been in the operating room for 30+ years. I have recently hired into a small rural facility and I was taken back when they placed their patients into the stirrups immediately after the patient was moved to the OR bed before anesthesia induction. I have never seen this done this way. In all my years and many other facilities we induced anesthesia first with the patient supine and positioned into lithotomy after the ET tube was secured.

I have tried to do some research on this and the only thing I can find is a reference to pre-position patients with back problems to allow them to determine what is comfortable. But the article did not detail if the patient was then left positioned in lithotomy or placed back into supine position for induction.

I can't find any definitive contraindications to doing it in this order other than 1. it prolongs the length of time the patient is in lithotomy thus increasing the risks associated with the position; 2. the hemodynamic issues; 3. normal airway issues addressed with lithotomy positioning. My nursing spidy senses are tingling though on the issues of anxiety and patient comfort. A patient feels vulnerable enough and that is not a emotionally comfortable position for a patient, anyway. thoughts, anyone? I don't want to rock the boat at my new facility if there isn't a best practice addressing this issue. Thanks!

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    The only time I have positioned a patient in lithotomy prior to induction was a patient who had a lot of potential for injuries and requested to be positioned while awake to ensure that the positioning wouldn't be an issue- and you can bet I documented my butt off over that. Intubation was a little awkward for anesthesia, but we made it work. I would never do this routinely- not only what you mentioned but also for patient privacy reasons (even when the gown is strategically draped), comfort, and potential for increased positioning injuries.

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    You sure you entered a hospital and not a time machine? ;)

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    Sounds problematic. I worked at a rural hospital with less than 25 beds. This place did everything ass-backwards and did not have to comply with JHACO rules since they were so small. It was an awful experience because I didn't agree with virtually anything that the RN's did. Most of them were born and raised in that area and had never worked anywhere else so they didn't have a clue how it was supposed to really be done. Pretty scary to watch that... I'm sure. Hey Maw... put ol' Bessy up in them there stirrups and let's git her to sleep.

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    I have been in the OR for 28 years, and I have only seen this done once as the patient requested it due to her back problems. I would not be comfortable with this practice at all, and would consult with AORN regarding this practice. I would have a discussion with the nurse manager and the clinical unit educator regarding this as well.

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    We had this very discussion recently and that's not how I'm being taught for every reason you said, plus most recent textbook is stating otherwise.

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