Trendelenburg

[anbuitachi]

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Got a patient 60 male coming for a long abdominal case for cancer which will require probably 8 hours of Trendelenburg. He has a history of basilar artery tortuosity compressions nerve 7 with symptoms. What would you do? Obviously t berg is contraindicated in aneurysms, increased ICP, and such. But tortuosity? Any inputs? Thought about a neurology consult but he's not inpatient and surgery can't wait much since it's cancer

 

[deleted875186]

I suppose I would do the case and warn the patient that his neuro symptoms may get worse after waking up. How bad are his symptoms from the nerve compression, are we talking facial muscle spasms or an all out facial droop or something.

 

[anbuitachi]

I suppose I would do the case and warn the patient that his neuro symptoms may get worse after waking up. How bad are his symptoms from the nerve compression, are we talking facial muscle spasms or an all out facial droop or something.

Just spasm.

 

[Iso4ane]

Find a bed put him in Trendeleburg and have him Valsalva hard, see if he gets more symptomatic.

 

[fakin' the funk]

Got a patient 60 male coming for a long abdominal case for cancer which will require probably 8 hours of Trendelenburg. He has a history of basilar artery tortuosity compressions nerve 7 with symptoms. What would you do? Obviously t berg is contraindicated in aneurysms, increased ICP, and such. But tortuosity? Any inputs? Thought about a neurology consult but he's not inpatient and surgery can't wait much since it's cancer

It's a cancer case, so it's really an issue of WHEN you do it, not IF you do it.

A neurologist should advise on the theoretical risk of palsy from that position for that amount of time. If pt understands, little you can or need to do. Can't see how this couldn't wait a couple days (at most, right?) for a neuro curbside.

Sidenote: if doing it open instead of laparoscopic, or some "lesser" procedure, shortens the case time and eliminates need for Tberg, AND the risk of those things is high, you could recommend to the surgeon that the case be done open.

 

[anbuitachi]

It's a cancer case, so it's really an issue of WHEN you do it, not IF you do it.

A neurologist should advise on the theoretical risk of palsy from that position for that amount of time. If pt understands, little you can or need to do. Can't see how this couldn't wait a couple days (at most, right?) for a neuro curbside.

Sidenote: if doing it open instead of laparoscopic, or some "lesser" procedure, shortens the case time and eliminates need for Tberg, AND the risk of those things is high, you could recommend to the surgeon that the case be done open.

Yea I was thinking of that. The issue is that it's a long case and if it gets delayed to another day it's hard to find a free OR cause it's a whole day case!