TRENDELENBURGA SITUATION

From Big Medical Encyclopedia

TRENDELENBURGA SITUATION

(F. Trendelenburg, is mute. the surgeon, 1844 — 1924) — a position of the patient on the operating table, at a cut it lies on spin, its basin at -


Fig. Patient on the operating table in a polo of a zheniya Trendelenbu of a rg.

it is lifted, and an upper part of a trunk and the head are inclined down at an angle to 45 °. That the patient did not slide off the operating table, the bottom of the panel of a table is bent at an angle 120 — 140, legs of the patient bind two straps, having wrapped oh around hips (over knees) and shins (over anklebones); besides, nadplochnik with elastic linings (fig.) use.

F. Trendelepburg offered this situation for bladder operations, female generative organs and a rectum. Thanks to an inclination of the operating table intestines are displaced to the upper floor of an abdominal cavity and the small pelvis becomes available to survey and manipulations of the surgeon. Etc. admitted especially reasonable at operations for tumors of a uterus and vaginovesical fistulas, at a stop of bleeding in the depth of a small pelvis. At rather short-term operations which were carried out under a mask anesthesia or local anesthesia at the patients who do not have associated diseases of a respiratory organs and blood circulations, shortcomings Other, caused by postural disturbances hemodynamics and ventilation noted still by F. Trendelenburg paled into insignificance with its advantages. Therefore Etc. up to the middle of 20 century it was widely used at operative measures on pelvic bodies.

Due to the achievements of surgery and anesthesiology of the indication to Other were sharply limited. The full relaxation of muscles during operation reached at a modern anesthesia provides freedom of surgical manipulations in a small basin without lowering of the head end of the operating table. At bleeding the area of a pelvic bottom can be drained by means of an electroaspirator. Besides, the specific weight of difficult and long operations increased, and contraindications to them in the presence of associated diseases decreased. In this regard negative sides Other gained great value. As showed researches A. P. Zilbera, expressiveness of postural disturbances of a hemodynamics and ventilation at the patients who are in Other (falling of the ABP, increase in the central venous pressure, tachycardia, decrease in minute volume of blood, increase in a venous inflow to heart, hypoventilation with a hypercapnia and an anoxemia, overflow by blood of vessels of a brain with danger of a stroke and amotio of a retina), stand in direct dependence on a tilt angle of the operating table, duration of finding of the patient in this situation and features of anesthesia. All these phenomena are especially expressed and dangerous at corpulent people with diseases of cardiovascular system, the expressed angiosclerosis of a brain and disturbances of ventilation, especially during the use миорелаксан-тов^ neuroleptics and peridural anesthesia; bystry transition from Other to horizontal position is most dangerous. In this regard in practice of modern surgery Other use seldom and at short-term operative measures, and incline the operating table only on 20 — 30 °, except for cases of acute anemia of a brain or regurgitation (see).

During the performing surgery in Other it is necessary to control constantly the ABP and the central venous pressure; at increase in the last it is necessary to reduce a tilt angle of the operating table.

Bibliography: B unyatyan A. A., Rya

of b G. A. and Manevich A. 3. Anesthesiology and resuscitation, M., 1977; 3 and l e r A. P. Operational situation and anesthesia, Petrozavodsk, 1961; Persianinov JI. C. Operational gynecology, M., 1976; Trendelenburg F. Uber Blassenscheidenfistel-operationen und iiber Beckenhochlagerung bei Operationen in der Bauchhohle, Samml., klin. Vortr., No. 355 (Chir. No. 109), S. 3372, 1890., H. S. Timofeev.

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