WordNet

cause to be in an appropriate place, state, or relation
a job in an organization; "he occupied a post in the treasury" (同)post, berth, office, spot, billet, place, situation
the arrangement of the body and its limbs; "he assumed an attitude of surrender" (同)posture, attitude
the spatial property of a place where or way in which something is situated; "the position of the hands on the clock"; "he specified the spatial relations of every piece of furniture on the stage" (同)spatial relation
(in team sports) the role assigned to an individual player; "what position does he play?"
the act of positing; an assumption taken as a postulate or axiom
the particular portion of space occupied by something; "he put the lamp back in its place" (同)place
a rationalized mental attitude (同)stance, posture
a way of regarding situations or topics etc.; "consider what follows from the positivist view" (同)view, perspective
the appropriate or customary location; "the cars were in position"

PrepTutorEJDIC

〈C〉『位置;場所』;所在地 / 〈U〉所定の位置,適所 / 〈C〉『姿勢』,構え / 〈U〉有利な地位(立場) / 〈C〉《通例単数形で》(周囲の状況と関連する)『立場,境遇』;形勢,情況 / 〈C〉見解,態度 / 〈C〉(…としての)勤め口,職《+『as(of)+名』》 / 〈C〉(…の中の)地位《+『in+名』》 / 〈U〉(特に高い)社会的地位 / 《副詞[句]を伴って》…‘を'適当な(特定の)場所に置く

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/02/04 00:51:30」(JST)

wiki en

Old depiction of the Trendelenburg position.

In the Trendelenburg position, the body is laid flat on the back (supine position) with the feet higher than the head by 15-30 degrees, in contrast to the reverse Trendelenburg position, where the body is tilted in the opposite direction. Trendelenburg is a standard position used in abdominal and gynecological surgery. It allows better access to the pelvic organs as gravity pulls the intestines away from the pelvis. It was named after the German surgeon Friedrich Trendelenburg.^[1]

In the past, Trendelenburg position was used for patients in hypovolemic shock, with the thought that it would help maintain blood flow to the brain. This is no longer recommended because research shows it to be counterproductive.^[2]

Trendelenburg position In Surgery.

Current uses

The Trendelenburg position along with the Valsalva maneuver, termed as modified-Valsalva maneuver, is used for the cardioversion of ventricular tachycardia^[3]
The Trendelenburg position is helpful in surgical reduction of an abdominal hernia.^[4]
The Trendelenburg position is also used when placing a central venous line.^[5] The Trendelenburg position uses gravity to assist in the filling and distension of the upper central veins when placing a central line in the internal jugular or subclavian veins. It is also used in the placement of an external jugular peripheral line for the same reason. It plays no role in the placement of a femoral central venous line.
The Trendelenburg position is also used in respiratory patients to create better perfusion.^[6]
The Trendelenburg position has occasionally been used to produce symptomatic relief from septum posticum cysts of the subarachnoid space in the spinal cord, but does not bring about any long term benefits.^[7]
The Trendelenburg position may be used for drainage images during endoscopic retrograde cholangiopancreatography. ^[8]

Obsolete uses

People with hypotension (low blood pressure) have historically been placed in the Trendelenburg position in hopes of increasing their cerebral perfusion pressure (the blood pressure to the brain). A 2005 review found the "Literature on the position was scarce, lacked strength, and seemed to be guided by 'expert opinion.'"^[9] A 2008 meta-analysis found adverse consequences to the use of the Trendelenburg position and recommended it be avoided.^[10] However, the passive leg raising test is a useful clinical guide to fluid resuscitation and can be used for effective autotransfusion.^[11]
The Trendelenburg position used to be the standard first aid position for shock.^[12]
The Trendelenburg position was used for injured scuba divers.^[13] Many experienced divers still believe this position is appropriate, but current scuba first aid professionals no longer advocate elevating the feet higher than the head. The Trendelenburg position in this case increases regurgitation and airway problems, causes the brain to swell, increases breathing difficulty, and has not been proven to be of any value.^[14] "Supine is fine" is a good, general rule for victims of submersion injuries unless they have fluid in the airway or are breathing, in which case they should be positioned on the side.

References

^ Enersen, Ole Daniel. "Trendelenburg's position". Whonamedit.com. Retrieved 2009-03-04.
^ Kettaneh N (2010). "Towards evidence-based emergency medicine: best BETs from the Manchester Royal Infirmary. BET 4. Use of the trendelenburg position to improve haemodynamics during hypovolaemic shock". Emergency Medicine Journal 27 (11): 877–8. doi:10.1136/emj.2010.104893. PMID 20972235.
^ "Postural modification to the standard Valsalva manoeuvre for emergency treatment of supraventricular tachycardias (REVERT): a randomised controlled trial.". Lancet. doi:10.1016/S0140-6736(15)61485-4. PMID 26314489. Retrieved 21 January 2016.
^ Buchwald H (1998). "Three helpful techniques for facilitating abdominal procedures, in particular for surgery in the obese". American Journal of Surgery 175 (1): 63–4. doi:10.1016/S0002-9610(97)00233-X. PMID 9445243.
^ Central Venous Access Imaging at eMedicine
^ Powers SK, Stewart MK, Landry G (1988). "Ventilatory and gas exchange dynamics in response to head-down tilt with and without venous occlusion". Aviation, Space, and Environmental Medicine 59 (3): 239–45. PMID 3355478.
^ Teng P, Rudner N (1960). "Multiple arachnoid diverticula". Archives of Neurology 2: 348–56. doi:10.1001/archneur.1960.03840090112015. PMID 13837415.
^ Leung, Joseph. "Fundamentals of ERCP". In Cotton, Peter B. ERCP. GastroHep.
^ Bridges N, Jarquin-Valdivia AA (2005). "Use of the Trendelenburg position as the resuscitation position: to T or not to T?". American Journal of Critical Care 14 (5): 364–8. PMID 16120887.
^ Kettaneh, Nicolas (October 30, 2008). "Use of the Trendelenburg Position to Improve Hemodynamics During Hypovolemic Shock". BestBets.
^ Terai C, Anada H, Matsushima S, Kawakami M, Okada Y (1996). "Effects of Trendelenburg versus passive leg raising: autotransfusion in humans". Intensive Care Medicine 22 (6): 613–4. doi:10.1007/BF01708113. PMID 8814487.
^ Johnson S, Henderson SO (2004). "Myth: the Trendelenburg position improves circulation in cases of shock". CJEM 6 (1): 48–9. doi:10.1017/S1481803500008915. PMID 17433146.
^ Stonier, JC (1985). "A study in prechamber treatment of cerebral air embolism patients by a first provider at Santa Catalina Island". Undersea Biomedical Research (Undersea and Hyperbaric Medical Society) 12 (1 supplement). Retrieved 2009-03-19.
^ Dysbarism at eMedicine

External links

Illustration of position in comparison to other positions
Human Kinetics' Victim Positioning
According to The Canadian Journal of Anesthesia

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

1. 中心静脈アクセスの概要 overview of central venous access
2. 術中にショック状態に陥った成人患者のマネージメント intraoperative management of shock in adults
3. 成人における腹腔鏡下手術および腹部ロボット手術のための麻酔 anesthesia for laparoscopic and abdominal robotic surgery in adults
4. 透析時以外血圧の安定した患者における透析中の低血圧 intradialytic hypotension in an otherwise stable patient
5. 脊髄麻酔：手技 spinal anesthesia technique

English Journal

Cerebral herniation associated with central venous catheter insertion: Risk assessment.

Ziai WC, Chandolu S, Geocadin RG.SourceDepartment of Neurology, Division of Neurosciences Critical Care, Anesthesia and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA. Electronic address: weziai@jhmi.edu.
Journal of critical care.J Crit Care.2013 Apr;28(2):189-95. doi: 10.1016/j.jcrc.2012.09.013. Epub 2012 Nov 14.
PURPOSE: Central venous catheters (CVCs) are often necessary to treat acute brain-injured patients. Four cases of cerebral herniation immediately following central venous catheterization were the impetus for an investigation of clinical and radiologic parameters associated with this complication.MAT
PMID 23159141

The influence of hip abductor weakness on frontal plane motion of the trunk and pelvis in patients with cerebral palsy.

Krautwurst BK, Wolf SI, Heitzmann DW, Gantz S, Braatz F, Dreher T.SourceHeidelberg University Clinics, Department for Orthopedics and Trauma Surgery, Schlierbacher Landstraße 200a, 66118 Heidelberg, Germany.
Research in developmental disabilities.Res Dev Disabil.2013 Apr;34(4):1198-203. doi: 10.1016/j.ridd.2012.12.018. Epub 2013 Feb 6.
Trendelenburg walking pattern is a common finding in various disorders, including cerebral palsy (CP), where it is seen in children and adults. Clinically, this deviation is viewed as a consequence of hip abductor weakness resulting in pelvic obliquity. Trunk lean to the ipsilateral side is a common
PMID 23396196

Japanese Journal

腹腔鏡下内肛門括約筋切除術後に下肢のAcute compartment syndromeをきたした進行下部直腸癌の1例

宗方幸二,竹政伊知朗,植村守,原口直紹,西村潤一,畑泰司,水島恒和,山本浩文,土岐祐一郎,森正樹
日本大腸肛門病学会雑誌 67(2), 97-102, 2014
手術に関連するAcute compartment syndrome（ACS）は稀であり，早期の診断と加療が重要である．腹腔鏡下内肛門括約筋切除術後に下肢のACSをきたした症例を経験したので報告する．症例は進行下部直腸癌の40歳代男性．術前検査で側方リンパ節転移が疑われ，術前化学療法後に腹腔鏡下内肛門括約筋切除術および治療的両側側方リンパ節郭清術を施行した．体位は開脚頭低位を基本とし，会陰操作と側方 …
NAID 130003394576

Cardiovascular and respiratory effects of the degree of head-down angle during robot-assisted laparoscopic radical prostatectomy

Kadono Yoshifumi,Yaegashi Hiroshi,Machioka Kazuaki,Ueno Satoru,Miwa Sotaro,Maeda Yuji,Miyagi Tohru,Mizokami Atsushi,Fujii Yuka,Tsubokawa Tsunehisa,Yamamoto Ken,Namiki Mikio
International Journal of Medical Robotics and Computer Assisted Surgery 9(1), 17-22, 2013-03
… Background: Robot-assisted laparoscopic radical prostatectomy (RALP) requires a steep Trendelenburg position and CO2 pneumoperitoneum for several hours to secure the surgical visual field. … The present study was performed to investigate the influence of each angle of Trendelenburg position during RALP on cardiovascular and respiratory homeostasis. …
NAID 120005253905

Three Cases of Laparoscopic Surgery after the Fontan Procedure

菅本健司,小川潔,星野健司,菱谷隆,斉藤千徳,藤本義隆,野村耕司,篠原玄,山本祐介,保科俊之,水戸野裕之,濱屋和泉,内田広夫
Pediatric Cardiology and Cardiac Surgery 29(1), 43-48, 2013
… In addition, mechanical ventilation and the Trendelenburg position during laparoscopic surgery may deteriorate passive pulmonary circulation due to increased intra-thoracic pressure. …
NAID 130003380011

「トレンデレンブルグ位」

　　[★]

英: Trendelenburg position
同: トレンデレンブルグ体位、骨盤高位
関: 体位

[show details]

トレンデレンブルグ位 : 98 件
トレンデレンブルグ体位 : 約 6,520 件
Trendelenburg位 : 約 96 件
Trendelenburg体位 : 約 602 件

頭を低く足を高くした体位

産婦人科：臍帯下垂の自然整復

循環血流量が減少している場合、トレンデレンブルグ位でも静脈還流量・心拍出量は増加しない。循環血液量が過剰なときには効果がある。(ICU.191)

参考

1. シェーマ

http://www.realself.com/files/352021-195712.png

2. シェーマ

http://best4med.com/view_video.php?viewkey=f50967c64dac2d639a57&page=1&viewtype=basic&category=

wiki en

http://en.wikipedia.org/wiki/Trendelenburg_position

「lithotomy-Trendelenburg position」

　　[★] 切石位トレンデレンブルグ体位

「position」

　　[★]

n.

位置、立場、状態、地位、ポジション、体位

v.

位置する

関: condition、lie、locate、location、loci、locus、map、postural、posture、rank、sit、situated、situation、stance、stand、standpoint、state、status、topo

[whonamedit-1] Enersen, Ole Daniel. "Trendelenburg's position". Whonamedit.com. Retrieved 2009-03-04.

[2] Kettaneh N (2010). "Towards evidence-based emergency medicine: best BETs from the Manchester Royal Infirmary. BET 4. Use of the trendelenburg position to improve haemodynamics during hypovolaemic shock". Emergency Medicine Journal 27 (11): 877–8. doi:10.1136/emj.2010.104893. PMID 20972235.

[3] "Postural modification to the standard Valsalva manoeuvre for emergency treatment of supraventricular tachycardias (REVERT): a randomised controlled trial.". Lancet. doi:10.1016/S0140-6736(15)61485-4. PMID 26314489. Retrieved 21 January 2016.

[pmid9445243-4] Buchwald H (1998). "Three helpful techniques for facilitating abdominal procedures, in particular for surgery in the obese". American Journal of Surgery 175 (1): 63–4. doi:10.1016/S0002-9610(97)00233-X. PMID 9445243.

[Amesur-5] Central Venous Access Imaging at eMedicine

[pmid3355478-6] Powers SK, Stewart MK, Landry G (1988). "Ventilatory and gas exchange dynamics in response to head-down tilt with and without venous occlusion". Aviation, Space, and Environmental Medicine 59 (3): 239–45. PMID 3355478.

[7] Teng P, Rudner N (1960). "Multiple arachnoid diverticula". Archives of Neurology 2: 348–56. doi:10.1001/archneur.1960.03840090112015. PMID 13837415.

[Fundamentals_of_ERCP-8] Leung, Joseph. "Fundamentals of ERCP". In Cotton, Peter B. ERCP. GastroHep.

[pmid16120887-9] Bridges N, Jarquin-Valdivia AA (2005). "Use of the Trendelenburg position as the resuscitation position: to T or not to T?". American Journal of Critical Care 14 (5): 364–8. PMID 16120887.

[10] Kettaneh, Nicolas (October 30, 2008). "Use of the Trendelenburg Position to Improve Hemodynamics During Hypovolemic Shock". BestBets.

[pmid8814487-11] Terai C, Anada H, Matsushima S, Kawakami M, Okada Y (1996). "Effects of Trendelenburg versus passive leg raising: autotransfusion in humans". Intensive Care Medicine 22 (6): 613–4. doi:10.1007/BF01708113. PMID 8814487.

[pmid17433146-12] Johnson S, Henderson SO (2004). "Myth: the Trendelenburg position improves circulation in cases of shock". CJEM 6 (1): 48–9. doi:10.1017/S1481803500008915. PMID 17433146.

[UHMSabstract-13] Stonier, JC (1985). "A study in prechamber treatment of cerebral air embolism patients by a first provider at Santa Catalina Island". Undersea Biomedical Research (Undersea and Hyperbaric Medical Society) 12 (1 supplement). Retrieved 2009-03-19.

[Dysbarism-14] Dysbarism at eMedicine

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案内

Trendelenburg position