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Journal of Indian Association of Pediatric Surgeons
     Journal of Indian Association of Pediatric Surgeons
Official journal of the Indian Association of Pediatric Surgeons         
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LETTER TO THE EDITOR
Year : 2013  |  Volume : 18  |  Issue : 1  |  Page : 41-42
 

Namaste position-an option for patient position in pediatric anorectal surgeries


1 Apollo Gleneagles Hospital, Kolkata, India
2 Bangur Institute of Neurology, Kolkata, India

Date of Web Publication7-Feb-2013

Correspondence Address:
Debasish Mitra
4A Satya Doctor Road, Kidderpur, Kolkata-23
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9261.107020

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How to cite this article:
Mitra D, Mitra I, Bhattacharyya S. Namaste position-an option for patient position in pediatric anorectal surgeries. J Indian Assoc Pediatr Surg 2013;18:41-2

How to cite this URL:
Mitra D, Mitra I, Bhattacharyya S. Namaste position-an option for patient position in pediatric anorectal surgeries. J Indian Assoc Pediatr Surg [serial online] 2013 [cited 2019 Nov 13];18:41-2. Available from: http://www.jiaps.com/text.asp?2013/18/1/41/107020


Sir,

Lithotomy position gives the best exposure for perineal and anorectal surgeries. But the stirrups used for lithotomy position in adults are not suitable for small children. Stirrups have been invented for use in very small children. These stirrups come in different sizes and angulations depending on the patient's age and position required and they do not have any angulation at the knees. [1] Although the stirrup adapted for pediatric use has no flexion at hip joint, it is still susceptible to nerve injury by the position of thigh and leg and by the pressure on calf by fixation. Damage to the perineal nerve, sciatic nerve, and femoral obturator nerve may occur. Another alternative position used is the frog position where the hips are hyper-abducted, hyper-flexed, externally rotated and the knees are full flexed. This position although gives good exposure, but is associated with extreme position of hip joint causing occasional femoral nerve injury. In both these positions the patient has to be fixed to the foot end of the bed and so any intra operative change in the patient's position, if needed, becomes very difficult. Again, there is always a risk of intra operative giving away of the fixation. So in this study we have described an alternate patient position to overcome these shortfalls.

The study included 31 patients, age ranging from 25 days to 2 years 8 months (average: 13.8 months). The male female ratio was 4:3. The surgeries performed were: Anorectal myectomy or rectal biopsy (18 patients), rectal polypectomy (six patients) and anoplasty (seven patients). After induction, the patients were brought down to the foot end of the table and the patient positioning was done. Both feet were joined together with adhesive tapes like hands saying namaste, which was then suspended from a rod above [Figure 1].Angulations of hip joint and knee joint were thus subjected to alteration according to the surgeon's preference. By moving the fixation rod cephalad, posterior perineum is well exposed and in similar way moving the rod caudal, anterior perineum is well exposed. The fixation was away from the sterile field but within sterile drapes. Also, the fixation did not come in way of the operating team during surgery. In none of the patients the fixation gave way or got disturbed by the movements of the surgical team during surgery. In two cases, there was intra operative anesthetic problem. Just by pulling the sheet under the patient cranially, the patients were easily brought to the head end without disturbing the sterility of the surgical field. After the anesthetic management, they were again brought down to the operating position by pulling back the sheath underneath.
Figure 1: Position on the table. Fixation away from the surgical field and at the center of the bed, not at foot end

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The new position used has been named "Namaste" position. Namaste is a common spoken greeting or salutation originating from the Indian subcontinent. It is a position with hands pressed together, palms touching and fingers pointing upwards, in front of the chest. The gesture is now widely used throughout Asia and beyond. [2] In this position, the feet are held together as hands doing "Namaste".

The position is very comfortable as it is the position children have during nappy changes. Since the patient is not fixed anywhere to the bed so intra operative change in the patient's position is easier. Furthermore, if there is any anesthetic problem, the child can be easily brought up to the head end of the table and then again brought down to the surgeon's position after the problem has been sorted out. Again, the surgeon can intraoperatively alter the angulation at the hip joint for adjusting the exposure of the operating site. Also, since the fixation remains away from the operating field and out of the way of the operating team, there is less chance of the fixation giving way intra operatively.

 
   References Top

1.Ohri SK, Deshmukh RG, Singh P. Pediatric stirrups for Anorectal surgery. Dis Colon Rectum 1991;34:421-2.  Back to cited text no. 1
[PUBMED]    
2.Chatterjee G. Sacred Hindu Symbols. 2001. p. 47-48.  Back to cited text no. 2
    


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