Читать книгу Management of Complications in Oral and Maxillofacial Surgery - Группа авторов - Страница 45

In an outpatient surgical procedure of limited duration, the risk of injury to a patient from malpositioning is relatively small. In susceptible patients, or for longer procedures, special care in patient positioning is prudent to avoid musculoskeletal injury. The provision of anesthesia causes relaxation of the musculoskeletal system that can lead to hyperextension of the joints. Also, prolonged patient immobility can contribute to venous stasis, peripheral blood pooling, and the creation of pressure points. Elderly patients, patients with a history of musculoskeletal injury or arthritis, and obese patients are at increased risk for complications related to patient positioning. Patients with Marfan syndrome, Ehlers–Danlos syndrome, or other disorders of joint hypermobility may also be at risk. Down syndrome (trisomy 21) patients have increased range of motion of the cervical spine vertebrae and are at increased risk for vertebral dislocation if the head or neck becomes hyperextended. Of specific concern to OMSs is the potential for injury to the that can occur in sedated patients due to prolonged or exaggerated opening of the mouth during surgery. Key preventive measures are positioning patients in neutral body positions, minimizing length of surgery in susceptible individuals, and ensuring that dental chairs are cushioned and sized appropriately for the patient.