CAN OPERATING ROOM TABLES BE MADE SAFER AND MORE COMFORTABLE?
Plastic and Reconstructive Surgery:Volume 109(1)January 2002p 407
Man, Daniel M.D.; Plosker, Harvey M.D.
As plastic surgical procedures have continued to become longer and more complex, and as the performance of combinations of procedures has become more commonplace, patients have spent increasingly longer periods of time immobile on the operating room table. This trend led to an increase in thrombo-embolic phenomena, which has been addressed by the widespread use of leg compression devices in an attempt to minimize the occurrence of these events. 1,2 However, another aspect of this prolonged period of immobility that has not been adequately addressed is patient discomfort related to mechanical forces between the patients' skin and the surface of the operating table. The three primary mechanical factors involved are pressure, shear, and friction. The combination of these three factors leads to a variety of effects on the body including impairment of local capillary blood flow, especially in regions of body prominences. These various effects, when combined, can cause discomfort, pain, and possibly even pressure sores and may contribute to the occurrence of thrombo-embolic phenomena.
We have found a device, the Cumulus Surface (Hill-Rom Surgical Surfaces, Acton, Mass), which is a pressure-relieving surface that replaces the operating room table mattress pad. This device is a microprocessor-controlled air-float mattress, which is made up of permanently inflated air cells that are surrounded by cylindrical cells that can inflate and deflate. The cells are designed to move with the patient so as to reduce shear. The microprocessor measures air pressure in three sections (head, torso, and feet) and optimizes the pressure in each section. Memory foam over the air cells provides extra comfort and helps protect the air cells from punctures or cuts. The patient floats on the pad and is completely supported, distributing pressure extremely effectively. Nonetheless, the mattress provides an extremely stable support surface, one that provides sufficient support for performing CPR.
If you have ever lain on a conventional operating room table, you are well aware that it is not very comfortable, and would certainly not be comfortable to lie on for several hours or more. When one lies on the Cumulus Surface, one gets the feeling of floating, whether in the supine, lateral, or prone position.
In our practice, we have always paid meticulous attention to patient comfort and safety and on our operating table have always employed egg-crate pads, heel pads, elbow pads, leg compression devices, etc. However, since beginning the use of this device, we have noted a marked reduction in patient complaints of pain in the back, neck, and various body prominences, including the occiput. When the device is used during extremely lengthy surgical procedures performed under regional anesthesia, such as replantations, we have seen a very clear improvement in patient comfort and a reduction in the need for analgesic and sedative medications. 3 Additionally, because the periodic inflation and deflation of the various zones create some movement, this device may afford some additional protection against the development of thrombo-embolic phenomena. We feel that this device is a valuable adjunct in providing a safe comfortable environment to our patients who have entrusted themselves to us.
We have no financial interest in this device.
Daniel Man, M.D.
Harvey Plosker, M.D.
References
1. Reinisch, J. F., Bresnick, S. D., Walker, J. W. T., and Rosso, R. F. Deep venous thrombosis and pulmonary embolus after face life: A study of incidence and prophylaxis. Plast. Reconstr. Surg. 107: 1570, 2001.
2. Stuzin, J. M., Baker, T. J., and Baker, T. M. Deep venous thrombosis and pulmonary embolus after face lift: A study of incidence and prophylaxis (Discussion). Plast. Reconstr. Surg. 107: 1576, 2001.
3. Inberg, P., Tarkkila, P. J., Neuvonen, P. J., and Vilkki, S. Regional anesthesia for microvascular surgery: A combination of brachial plexus, spinal and epidural blocks. Reg. Anesth. 18: 98, 1993.
