Original Article

Surgeons’ Perspectives on Optimal Patient Positioning During Simultaneous Cranial Procedures and Exploratory Laparotomy

Authors: Alejandra M. Hernandez, BA, Marie Roguski, MD, Robert S. Qiu, BA, Matthew J. Shepard, BS, Ron I. Riesenburger, MD

Abstract

Objectives: Patients presenting with traumatic intracranial and intraabdominal injuries often require emergent care. Triage of injuries is based on severity of the individual injuries, but treatment occasionally must proceed simultaneously. Determining an optimal patient position at the time of surgery often produces unnecessary delays and this delay may negatively affect patient outcome. This study aimed to determine an operative patient position that simultaneously optimizes access to neurosurgical and general surgical teams without compromising sterility or severely affecting surgeon and anesthesia comfort.

Methods: Photographs of traditional exploratory laparotomy patient positioning (position A), traditional supine craniotomy patient positioning (position B), and a hybrid patient position (position C) were presented to 29 general surgeons and 12 neurosurgeons at a single institution. Surgeons were asked to rate the positions on acceptability and to rank the three positions according to preference when simultaneous exploratory laparotomy and craniotomy were necessary.

Results: Position C was rated as an acceptable option by 82.8% of general surgeons and 100% of neurosurgeons. In addition, 51.9% of general surgeons and 81.8% of neurosurgeons preferred position C to their respective specialty’s traditional patient positioning in situations that required simultaneous exploratory laparotomy and craniotomy.

Conclusions: We present a novel hybrid operative patient position for use during simultaneous exploratory laparotomy and craniotomy. In doing so, we emphasize the importance of constructive dialogue among trauma surgeons and neurosurgeons in optimizing the care of acutely ill trauma patients with multisystem injuries.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Gennarelli TA, Champion HR, Sacco WJ, et al. Mortality of patients with head injury and extracranial injury treated in trauma centers. J Trauma. 1989; 29: 1193–1201.
 
2. Wisner DH, Victor NS, Holcroft JW. Priorities in the management of multiple trauma: intracranial versus intra-abdominal injury. J Trauma. 1993; 35: 271–276.
 
3. Melio FR. Priorities in the multiple trauma patient. Emerg Med Clin North Am. 1998; 16: 29–43.
 
4. Moore FA, Moore EE. Initial management of life-threatening trauma. In: Ashley SW, Wilmore DW., eds. ACS Surgery—Principles & Practice. Toronto: BC Decker; 2005; : 1–20.
 
5. Fukai J, Tsujimoto T, Yoshimura R, et al. Timing of craniotomy in a patient with multiple trauma including head injury. Neurol Med Chir. 2009; 49: 22–25.
 
6. Holcomb JB. Simultaneous intracranial and abdominal injury: which gets operated on first and which has the higher treatment priority? In: Valadka AB, Andrews BT. , eds. Neurotrauma. New York: Thieme Medical Publishers; 2005: 175–178.
 
7. Krettek C, Simon RG, Tscherne H. Management priorities in patients with polytrauma. Langenbecks Arch Surg. 1998; 38: 220–227.
 
8. Huang MS, Shih HC, Wu JK, et al. Urgent laparotomy versus emergency craniotomy for multiple trauma with head injury patients. J Trauma. 1995; 38: 154–157.
 
9. The Brain Trauma Foundation The American Association of Neurological Surgeons The Joint Section on Neurotrauma and Critical Care. Hypotension. J Neurotrauma. 2000; 17: 591–595.
 
10. Thomason M, Messick J, Rutledge R, et al. Head CT scanning versus urgent exploration in the hypotensive blunt trauma patient. J Trauma. 1993; 34: 40–44.
 
11. Houshian S, Larsen MS, Holm C. Missed injuries in a level I trauma center. J Trauma. 2002; 52: 715–719.
 
12. Warner MA. Perioperative neuropathies. Mayo Clin Proc. 1998; 73: 567–574.
 
13. Eggstein S, Franke M, Hofmeister A, et al. Postoperative peripheral neuropathies in general surgery. Zentralbl Chir. 2000; 125: 459–463.
 
14. Agostini J, Goasguen N, Mosnier H. Patient positioning in laparoscopic surgery: tricks and tips. J Visc Surg. 2010; 147: 227–232.