PR Posisi

lumbotomi & prone

Oleh :
Danur Adi Kusuma
Morgan, ed5
barash, 2013
 LUMBOTOMI
flexed lateral decubitus

Miller, Ed8
 LUMBOTOMI
flexed lateral decubitus
• Patients  flexed while lateral position to
improve exposure of the retroperitoneum for
renal surgeries.
• Head-down tilt in the lateral position worsens
pulmonary function yet further, increasing shunt
fraction
• This position is often accompanied by a
component of reverse Trendelenburg positioning,
creating the potential for venous pooling in the
lower body.
Miller, Ed8
• In a patient who is mechanically ventilated, 
lateral weight of the mediastinum, cephalad
pressure of abdominal contents on the
dependent lung  overventilation
nondependent lung. At the same time, the effect
of gravity causes the pulmonary blood flow to
the underventilated, dependent lung to
increase.

Miller, Ed8
• head  neutral position to prevent excessive lateral
rotation of the neck and stretch injuries brachial
plexus.
• The dependent ear should be checked to avoid
folding and undue pressure.
• The eyes  taped closed before repositioning
(asleep). The dependent eye must be frequently
checked for external compression.
• To avoid compression to the dependent brachial
plexus or blood vessels, an axillary roll (a bag of
intravenous fluid), is frequently placed between the
chest wall and the bed
Miller, Ed8
PRONE
 PRONE
- Surgical access  posterior fossa of the skull, the posterior spine, the
buttocks and perirectal area, and the lower extremities.

- if the legs are in plane with the torso, hemodynamic reserve is

maintained; however, if there is any significant lowering of the legs or
tilt of the entire table, venous return may be decreased or augmented
accordingly.

- Pulmonary function may be superior to the supine or lateral decubitus

positions if there is no significant abdominal pressure, and the patient is
properly positioned.
Miller, Ed8
• External pressure on the abdomen may push the
diaphragm cephalad, decreasing functional residual
capacity and pulmonary compliance, and increasing peak
airway pressure.
• Abdominal pressure also may impede venous return
through compression of the inferior vena cava. For these
reasons, careful attention must be paid to the ability of the
abdomen to hang free and to move with respiration.

Miller, Ed8