The reverse Trendelenburg, also called the anti-Trendelenburg, is a common surgical position in which the lower extremities are levelled lower than the head and neck. It is the opposite of the Trendelenburg position, in which the head and the neck are below the lower extremities. The reverse Trendelenburg is used in numerous surgical procedures and presents multiple benefits, as well as some risks.
The reverse Trendelenburg is a variation of the Trendelenburg position, which was introduced by German surgeon Friedrich Trendelenburg. The Trendelenburg position was first used in the 1860s to improve visual access of the pelvis and lower abdomen during surgery.
Reverse Trendelenburg Position
A patient is laid flat on a surgical table in the head-up, feet-down position. The patient must be tilted in and out of the reverse Trendelenburg position slowly to avoid sudden shifts in blood pressure. A secure padded foot rest at the base of the surgical table prevents the patient from slipping off. The patient is additionally restrained by a body sheet placed firmly around the arms, foot restraints and a foot board. Malnourished and elderly patients may require additional sheepskin bootees or padding at the heels to protect them from pressure points. Legs must remain uncrossed to decrease the risk of thrombosis and relieve pressure.
The reverse Trendelenburg is an unnatural position, and complications can occur. Patients should not be left unattended while in the position, for they are liable to slide off the table. Excessive pressure may cause vital signs, such as blood pressure, temperature, heart rate and pulse, to drop, so the patient must be constantly monitored.
Reverse Trendelenburg has little effects on respiration but compromises the circulation of blood. A considerable volume of blood is pooled towards the lower extremities, resulting in reduced cardiac output.
The reverse Trendelenburg position is used to treat venous air embolism, improve the flow of blood to the cerebral regions, achieve an effective level of epidural or spinal anaesthesia, prevent pulmonary aspiration due to vomiting and engorge vessels of the cervix for the placement of a central venous catheter. The position is also used for neck and head surgery and gynaecological procedures because it reduces the flow of blood to those areas. The reverse Trendelenburg facilitates respiration in overweight and obese patients. Putting an overweight patient in the position alleviates pressure on the head due to the excessive weight of the abdomen during ophthalmic surgery. The reverse Trendelenburg position is also used to improve surgical exposure of the prostate and in minimally invasive upper abdominal procedures.