Background: Compartment syndrome of a lower extremity from hypoperfusion is
a rare but potentially devastating complication of the lithotomy position
during surgery. The aim of this study is to determine the effects of variou
s lithotomy positions on lower-extremity blood pressures.
Methods: Blood pressure in eight young, healthy people was studied for 10 l
ithotomy positions. Blood pressure measurements were taken in both the uppe
r arm (brachial artery) and the lower extremity (dorsalis pedis). The heart
-to-ankle height gradient in each position was measured, and a predicted lo
wer-extremity systolic pressure was calculated. The measured and predicted
lower-extremity systolic blood pressures were compared with repeated measur
es analysis of variance,
Results: As a group, the mean systolic blood pressures in the lower extremi
ties correlated closely with the predicted values. However, the difference
between measured and predicted pressures varied among the 10 positions (P <
0.05).
Conclusions: Although lower-extremity systolic blood pressures In the young
, healthy volunteers correlated with predicted values, there was an additio
nal reduction in pressure associated with the Lithotomy position. This surp
rising finding suggests that a lengthy procedure necessitating the use of a
lithotomy position for only a portion should be planned so the remainder o
f the procedure can take place before establishing the position or so the p
osition can be changed to an alternative position when it Is no longer need
ed.