Survey of anesthesiologists' practices related to steep Trendelenburg positioning in the USA

Research output: Contribution to journalArticle

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Abstract

Background: Steep Trendelenburg during surgery has been associated with many position-related injuries. The American Society of Anesthesiology practice advisory recommends documentation, frequent position checks, avoiding shoulder braces, and limiting abduction of upper extremities to avoid brachial plexopathy. We conducted a web-based survey to assess anesthesiologists' practices, institutional policies, and complications encountered when using steep Trendelenburg. Methods: Two thousand fifty randomly selected active members of the American Society of Anesthesiology were invited via email to participate in a 9-item web-based survey. Results are reported as absolute numbers and proportions with 95% confidence interval (CI). Results: Survey response rate was 290 of 2050 (14.1%). 44.6% (95% CI, 38.9-50.3) of the respondents documented anesthesia start and finish, 73.9% (95% CI, 68.8-79) frequently checked positioning during surgery, 30.8% (95% CI, 25.4-36.2) reported using shoulder braces, 66.9% (95% CI, 61.5-72.3) tucked patients' arms to the side, 54.0% (95% CI, 48.2-59.8) limited fluid administration, and more than two-thirds did not limit the duration or inclination angle. Notably, 63/290 (21.7%) reported a complication and only 6/289 (2.1%) had an institutional policy. The most common complication was airway and face edema, second was brachial plexus injury, and third was corneal abrasions. Most institutional policies, when present, focused on limiting duration of steep Trendelenburg and communication with surgical team. Only 1/6 policies required avoiding use of shoulder braces. Conclusion: Based on survey results, practices related to steep Trendelenburg varied among USA anesthesiologists. Differences included protective measures, documentation, positioning techniques, fluid management, and institutional guidelines. The singular commonality found among all respondents was lack of institutional policies. Survey results highlighted the need for institutional policies and more education.

Original languageEnglish (US)
Article number117
JournalBMC Anesthesiology
Volume18
Issue number1
DOIs
StatePublished - Aug 21 2018

Fingerprint

Organizational Policy
Confidence Intervals
Braces
Anesthesiology
Documentation
Arm Injuries
Brachial Plexus Neuropathies
Brachial Plexus
Anesthesiologists
Surveys and Questionnaires
Upper Extremity
Edema
Arm
Anesthesia
Communication
Guidelines
Education
Wounds and Injuries

Keywords

  • Anesthesia practices
  • Anesthesia survey
  • Laparoscopy complications
  • Positioning injuries
  • Steep Trendelenburg
  • Trendelenburg complications

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Survey of anesthesiologists' practices related to steep Trendelenburg positioning in the USA. / Souki, Fouad; Rodriguez, Yiliam; Polu, Sravankumar Reddy; Eber, Scott; Candiotti, Keith A.

In: BMC Anesthesiology, Vol. 18, No. 1, 117, 21.08.2018.

Research output: Contribution to journalArticle

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abstract = "Background: Steep Trendelenburg during surgery has been associated with many position-related injuries. The American Society of Anesthesiology practice advisory recommends documentation, frequent position checks, avoiding shoulder braces, and limiting abduction of upper extremities to avoid brachial plexopathy. We conducted a web-based survey to assess anesthesiologists' practices, institutional policies, and complications encountered when using steep Trendelenburg. Methods: Two thousand fifty randomly selected active members of the American Society of Anesthesiology were invited via email to participate in a 9-item web-based survey. Results are reported as absolute numbers and proportions with 95{\%} confidence interval (CI). Results: Survey response rate was 290 of 2050 (14.1{\%}). 44.6{\%} (95{\%} CI, 38.9-50.3) of the respondents documented anesthesia start and finish, 73.9{\%} (95{\%} CI, 68.8-79) frequently checked positioning during surgery, 30.8{\%} (95{\%} CI, 25.4-36.2) reported using shoulder braces, 66.9{\%} (95{\%} CI, 61.5-72.3) tucked patients' arms to the side, 54.0{\%} (95{\%} CI, 48.2-59.8) limited fluid administration, and more than two-thirds did not limit the duration or inclination angle. Notably, 63/290 (21.7{\%}) reported a complication and only 6/289 (2.1{\%}) had an institutional policy. The most common complication was airway and face edema, second was brachial plexus injury, and third was corneal abrasions. Most institutional policies, when present, focused on limiting duration of steep Trendelenburg and communication with surgical team. Only 1/6 policies required avoiding use of shoulder braces. Conclusion: Based on survey results, practices related to steep Trendelenburg varied among USA anesthesiologists. Differences included protective measures, documentation, positioning techniques, fluid management, and institutional guidelines. The singular commonality found among all respondents was lack of institutional policies. Survey results highlighted the need for institutional policies and more education.",
keywords = "Anesthesia practices, Anesthesia survey, Laparoscopy complications, Positioning injuries, Steep Trendelenburg, Trendelenburg complications",
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