Position: Trendelenburg
Time: 1-2 hours (average)
Blood Loss: Low (10-50 ml)
Post-op Pain: Minimal (1-3)
Maintenance Paralytic: Yes

At the end of the case, the patient will be brought out of trendelenburg and flattened, and the doctor will briefly (10-15 min) work between the legs. This is the end of the case.

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Trendelenburg Position (general considerations): Take precautions for upper airway obstruction or stridor. Avoid excessive fluid administration. OG tube is a good consideration to empty the contents of the stomach. Regurgitation of stomach contents can ulcerate the airway and/or damage the eyes. Consider throat packs and/or eye lubrication to further protect the patient. Brachial nerve injury is also a strong possibility. Be very careful with head and shoulder brace positioning. Peroneal nerve injury is a strong possibility if the patient is also in the lithotomy position. Make sure pressure points are padded. If there’s peroneal nerve damage, it will manifest as foot drop. Increased IOP. Take precaution with patients that have glaucoma. Conjunctival swelling will sometimes be irritating to the patient post-operatively. Keep reminding the patient not to rub their eyes. Increased ICP. Cerebral perfusion pressure = MAP-ICP. Make sure you keep the MAP up.

A colporrhaphy is the repair of a defect in the vaginal wall. This defect has begun to interfere with activities of daily living or it is typically not surgically corrected. An anterior colporrhaphy will be treating a defect due to a cystocele or urethrocele, and a posterior colporrhaphy is reserved for a rectocele.