Trendelenburg position

The Trendelenburg position is used in surgery, especially of the abdomen and genitourinary system. It allows better access to the pelvic organs as gravity pulls the intra-abdominal organs away from the pelvis. Evidence does not support its use in hypovolaemic shock, with concerns for negative effects on the lungs and brain.

Most recently, the Reverse Trendelenburg position has been used in minimally invasive glaucoma surgery, also known as MIGS. This position is commonly used for a superior sitting surgeon that uses a combination of downward patient tilt, of approximately 30 to 35 degrees, microscope tilt towards themselves at the same angle and an intraoperative gonio lens or prisms that allows them to visualise the inferior trabecular meshwork. Some joysticking of the globe may be required with an appropriate goniolens to bring the meshwork into view. (Source: en.wikipedia.org)

POSITION

The Trendelenburg position was originally used to improve surgical exposure of the pelvic organs. It’s credited to German surgeon Friedrich Trendelenburg (1844-1924). After World War I, use of the Trendelenburg position became common practice in managing patients with shock. The position was later used to prevent air embolism during central venous cannulation and to enhance the effects of spinal anesthesia. (Source:

In World War I, Walter Cannon, an American physiologist, popularized the use of the Trendelenburg position as a treatment for shock. The Trendelenburg position involves the patient being placed with their head down and feet elevated. This position was promoted as a way to increase venous return to the heart, increase cardiac output and improve vital organ perfusion. A decade later, Cannon reversed his opinion regarding the use of the Trendelenburg position, but this didn’t deter its widespread use. The Trendelenburg position is still a pervasive treatment for shock despite numerous studies failing to show effectiveness. (Source: www.jems.com)

Background: Because of the increase in intraocular pressure (IOP) that occurs in the Trendelenburg position, patients undergoing surgery in this position may be at risk for postoperative vision loss and other ocular complications. IOPs higher than 21 millimeters of mercury (mmHg) pose a risk for glaucoma, detached retina, and postoperative vision loss. The purpose of this systematic review and meta-analysis is to estimate the magnitude of the increase in IOP in adult patients undergoing surgery in the Trendelenburg position. (Source: ales.amegroups.com)

ales.amegroups.com)In the Trendelenburg position, the patient’s feet are higher than the patient’s head by 15 to 30 degrees (1). Many surgeons use a steep Trendelenburg position of 30 to 45 degrees, particularly during laparoscopic and robotic surgery. The benefit of the Trendelenburg position is that it moves the abdominal viscera cephalad to improve visibility and surgical access to the abdominal and pelvic organs. However, there are potential harms associated with the Trendelenburg position. The Trendelenburg position increases intraocular pressure (IOP) (2-10). According to the American Academy of Ophthalmology (11), normal IOP is 10 millimeters of mercury (mmHg) to 21 mmHg. IOPs higher than 21 mmHg pose a risk for glaucoma, detached retina, and postoperative vision loss (3,5,10,12-18). (Source: