Anatomy, Hand Positioning

Appropriate hand, fingers, wrist, and forearm positioning is often required to facilitate proper exposure to the surgical site and anesthesia administration with easy accessibility to the intravenous (IV) site and the American Society of Anesthesiology (ASA) monitors for the anesthesiologist. The most common surgical positioning is supine, Trendelenburg, and lithotomy position. These positions often require arms in abduction less than 90-degree rested on the armrest or tugged in the neutral position. Whereas in the lateral position, the bottom limb is padded at bony prominence and placed in front of the patient, and the top limb is placed on top with padding in between the arms or flexed at shoulder and elbow. Prone position arms are abducted, but abduction should not exceed more than 90 degrees. An axillary roll is often utilized during prone positioning to prevent compression of the brachial plexus and axillary vascular structures.