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BMC Anesthesiology
Published in: BMC Anesthesiology 1/2018

Open Access 01-12-2018 | Research article

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

Authors: Fouad G. Souki, Yiliam F. Rodriguez-Blanco, Sravankumar Reddy Polu, Scott Eber, Keith A. Candiotti

Published in: BMC Anesthesiology | Issue 1/2018

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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.
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Metadata
Title
Survey of anesthesiologists’ practices related to steep Trendelenburg positioning in the USA
Authors
Fouad G. Souki
Yiliam F. Rodriguez-Blanco
Sravankumar Reddy Polu
Scott Eber
Keith A. Candiotti
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Anesthesiology / Issue 1/2018
Electronic ISSN: 1471-2253
DOI
https://doi.org/10.1186/s12871-018-0578-5

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