Posture in thoracic surgery.

It is important in thoracic surgery to find a position upon the operating table which will combine good surgical access with the minimum interference with respiration. Present practice favours a postero-lateral approach for most thoracotomies, and for this the patient is placed with the gobod side of the chest under. The lateral position is maintained by a pad against the front of the chest and by pelvic and buttock supports which prevent rolling or slipping if the table is tilted. A padded wedge or pillow is sometimes placed under the thorax so as to bow the chest, opening the rib spaces on the upper side and so facilitating the exposure. Sellors' " chest-rest" combines the wedge and the anterior support in one piece. This position gives an excellent exposure for the surgeon but interferes with respiratory exchange. It has been stated, as a result of the investigations of Bjorkman and Jacobeus in bronchospirometry (Bjorkman, 1934), that with a patient lying in the lateral position the lower lung has the greater respiratory exchange. This appears to be a fortuitous advantage accruing from a position which has been adopted because of its surgical convenience; but when the chest is open the tidal air into the lower lung is reduced; and, unless methods are adopted to assist ventilation, anoxia develops.