OT table

1. Operation Theatre
Table
COMPILED AND PRESENTED BY:
DR. JUDITH JUSTIN M.TECH., PH.D.,
Prof. & Head,
Department of Biomedical Instrumentation Engineering
Faculty of Engineering
Avinashilingam University
Coimbatore - 641 108

2. INTRODUCTION
 Room where surgery is performed is
called an Operating Room (OR) or
Operation Theatre
 OR is different from other rooms in the
hospital because
i) The environment is controlled
ii) Special electrical wiring is done
iii) It is clean
iv) Different emergency equipment
 Inside the OR, the ambient temperature is
set to between 20-21◦ C
 The humidity is regulated to 50%. These
are achieved by air conditioners.
 Also incorporated into the inlet path of the
air to the OR are HEPA (High Efficiency
Particle Absorbers) filters which minimize
the dust entering into the OR

3. INTRODUCTION
 The operation table on which the
patient is positioned for surgery is
fully adjustable for:
• Height,
• Degree of tilt in all directions,
• Orientation in the room,
• Articular breaks and lengths
 This allows manipulation of the
patient in any position while
maintaining proper body allignment.
 The surface is covered with a firm pad
that can be removed for cleaning

4. ACCESSORIES
 Removable arm boards: allow extension of
the patients arms and hands for IV lines. This
surgical arm board is wider and provides a
broader surface on which to place the hand
 Leg holder: provide access to the knee
when it must be held up away from the table
surface. A special table top cassette
attachment accepts X-ray cassettes when
the operative procedure requires radiographs
 Back table: is a large table on which all
instruments are placed during surgery.
Before surgery, a sterile linen pack is opened
on to the table and sterile supplies are
placed. After donning gloves, the nurse
arranges these in an orderly fashion
 Mayo stand: is a tray supported by 2 legs
that is placed adjacent and very near to the
operative site. Instruments that are used
frequently are placed here where it is
immediately accessible. This stand is
adjustable and may be placed over(above)
the table, but never in contact with the
patient.

5. ACCESSORIES
 Gerhardth (overhead) table: is a combination of
Mayo stand and backtable. The overhead table
is positioned over, but not touching the patient.
The large surface of table provides access to
numerous instruments and supplies without the
use of a back table. The sizes and contours of
the table along with all the other accessories are
standardized to accommodate all patients
irrespective of their size. The table is also made
to withstand various weights.
 The table is powered by electromechanical or
electro-pneumatic methods. The table can be
operated by a hand control placed on the side.
Hand control is a membrane type, feather touch
to adjust all electro-hydraulic movements. It is
shock free, operating on DC 12V with a flexible
cable.
 Most of the tables give a foot switch control
enabling the surgeon to manipulate it to his
comfort. The table is made up of stainless steel
with smooth contours. It can be cleaned easily
with spray disinfectants and blood removing
agents. Since it is electrically operated, the
leakage current should be tested periodically.

6. SPECIAL FEATURES
 Operation table is used for general surgery
and other certain procedures. It provides
smooth, easy and accurate positioning.
 It is fully maneuverable by finger tip
operated feather touch keys on a remote
control hand switch.
 Unique, sensor controlled leveling for Lateral
and Trendelenberg positions.
 Movement is controlled by high pressure
electro-hydraulic system to achieve smooth
and efficient operation, without the slightest
jerk from start to the end.
 The manifold has flow control valves for
adjusting the desired speed of the table
movement to high accuracy.
 Hydraulic motor pump with long operating
life is fitted with anti-vibration mountings and
auto thermal cut-off.

7. SPECIAL FEATURES …CONTD.
 Remote control hand unit operates on extra safe 12V DC.
 Legible and easily identifiable symbols on switches provide
correct selection of table positions at any stage of operation.
 Full length cassette tunnel to move X-ray cassette. Special quick
change clamp to hold cassette firmly at any position.
 Radio translucent top.
 Durable & hygienic base cover made of stainless steel.

8. MANUAL ADJUSTMENTS
 Head section can be moved mechanically.
 Detachable for fixing neuro hand rest
 Table is mounted on castor wheels, its movement in the operation
theatre is smooth
 Mechanical pedal brakes for firm and rigid locking of table.
 When brake is released, the table is free to move on its castors

9. ATTACHMENTS …..CONTD.
 Shoulder support
 Lateral support, Universal
lateral support
 General purpose head
support
 Knee rest
 Knee crutches
 Raised arm board
 Arm board
 Kidney elevator
 Anesthetic screen frame
 Cassette holder, lateral
cassette hold
 Cassette tray with
adjustable rod
 Douche tray, Douche tray
with drain bucket

10. IMPORTANCE OF PROPER POSITIONING
Why do we need proper positioning?
 To maintain patient’s airway and avoid constriction or pressure on
the chest cavity
 To maintain circulation
 To prevent nerve damage
 To provide adequate exposure of the operative site
 To provide comfort and safety to the patient

11. BASIC SURGICAL POSITIONS
Variations include :
 Trendelenburg
 Reverse Trendelenburg
 Jackknife
 Fowler’s
 High Lithotomy
 Low Lithotomy
Four basic surgical positions
 Supine
 Prone
 Lateral
 Lithotomy

12. ONE LAST NOTE…
Positioning problems can result in
significant injuries and
successful lawsuits.

13. SUPINE
 Most common with the least amount of harm
 Placed on back with legs extended and uncrossed at the ankles
 Arms either on arm boards abducted <90* with palms up or
tucked (not touching metal or constricted)
 Spinal column should be in alignment with legs parallel to the OR bed
 Head in line with the spine and the face is upward
 Hips are parallel to the spine
 Padding is placed under the head, arms, and heels with a pillow placed
under the knees
 Safety belt placed 2” above the knees while not impeding circulation

14. PRONE
 Anesthetized supine, usually on the stretcher, prior to turning
 Turning is synchronized and supported
 Face down, resting on the abdomen and chest
 Chest rolls x2 placed lengthwise under the axilla and along the sides of the
chest from the clavicle to iliac crests
(to raise the weight of the body off of the abdomen and thorax)
 One roll is placed at the iliac or pelvic level
 Arms lie at the sides or over head on arm boards (must lower arms slowly to
the ground then bring them up in an arc to place on arm boards)
 Head is face down and turned to one side with accessible airway
 Forehead, eyes and chin are protected
 Padding to bilateral arms and under Knees
 Pillow placed under bilateral feet (for maintenance of foot extension)
 Female breasts and male genitalia must be free from pressure and torsion
 Safety strap placed 2” above knees

15. LATERAL
 Anesthetized supine prior to turning
 Shoulder & hips turned simultaneously to prevent
torsion of the spine & great vessels
 Lower leg is flexed at the hip; upper leg is straight
 Head must be in cervical alignment with the spine
 Breasts and genitalia to be free from torsion and pressure
 Axillary roll placed to the axillary area of the downside arm
(to protect brachial plexus)
 Padding placed under lower leg, to ankle and foot of upper leg, and to
lower arm (palm up) and upper arm
 Pillow placed lengthwise between legs and between arms (if lateral
 arm holder is not used)
Stabilize patient with safety strap and silk tape, if needed

16. TRENDELENBURG
 The patient is placed in the supine position while the OR bed
is modified to a head-down tilt of 35 to 45 degrees resulting in
the head being lower than the pelvis
 Arms are in a comfortable position – either at the side or on
bilateral arm boards
 The foot of the OR bed is lowered to a desired angle
 Velcro adhesive MUST be checked prior to placing the
patient on the table padding
 Surgical tape may be indicated to assure the table padding is
fixed to the table to prevent pad slippage
 In addition to a safety strap, strips of 3” tape may be used
to assist with holding the patient in the proper position
 Used for procedures in the lower abdomen or pelvis
 Enables the abdominal viscera to be moved away from the
pelvic area for better exposure

17. REVERSE TRENDELENBURG
 The entire OR bed is tilted so the head is higher than the feet
 Used for head and neck procedures
 Facilitates exposure, aids in breathing and decreases blood supply to
the area
 A padded footboard is used to prevent the patient from sliding
toward the foot

18. FOWLER’S POSITION
 Patient begins in the supine position
 Foot of the OR bed is lowered slightly, flexing the knees, while
the body section is raised to 35 – 45 degrees, thereby becoming
a backrest
 The entire OR bed is tilted slightly with the head end downward
(preventing the patient from sliding)
 Feet rest against a padded footboard
 Arms are crossed loosely over the abdomen and taped or placed
on a pillow on the patient’s lap
 A pillow is placed under the knees.
 For cranial procedures, the head is supported in a head rest
and/or with sterile tongs
 This position can be used for shoulder or breast reconstruction
procedures

19. JACKKNIFE
 Modification of the prone position
 The patient is placed in the prone position on the OR bed
and then inverted in a V position
 The hips are over the center break of the OR bed
between the body and leg sections
 Chest rolls are placed to raise the chest
 Arms are extended on angled arm boards with the elbows
flexed and the palms down
 A pillow is placed under the ankles to free the feet and
toes of pressure
 The OR bed leg section is lowered, and the OR bed is
flexed at a 90 degree angle so that the hips are elevated
above the rest of the body
 Used in gluteal and anorectal procedures

20. LITHOTOMY
 With the patient in the supine position, the legs are raised
and abducted to expose the perineal region
 The patient’s buttocks are even with the lower break in
the OR bed (to prevent lumbosacral strain)
 The arms are placed on padded arm boards, tucked at the
sides, or placed across the abdomen
 The legs and feet are placed in stirrups that support the
lower extremities
 Stirrups should be placed at an even height
 The legs are raised, positioned, and lowered slowly and
simultaneously, with the permission of the anesthesia care
provider
 Adequate padding and support for the legs/feet should
eliminate pressure on joints and nervus plexus
 The position must be symmetrical
 The perineum should be in line with the longitudinal axis of
the OR bed
The pelvis should be level
The head and trunk should be in a straight line
High Lithotomy
Low Lithotomy