Psychological Skills for Pediatric Pain Management

Changes in body position and perhaps more importantly the extremes of positioning can have significant hemodynamic changes which can be exaggerated in patients with systemic disease processes. Moreover, general as well as regional anesthesia can limit cardiovascular and pulmonary responses to these hemodynamic changes. Cardiovascular changes associated with reverse Trendelenburg positioning include decreased preload, cardiac output, and arterial blood pressure. Baroreflexes reflexively lead to increased sympathetic tone, heart rate, and peripheral vascular resistance as compensation. Respiratory changes include decreased work of breathing and increased functional residual capacity. Neurological changes include reduced cerebral perfusion pressure as well as decreased cerebral blood flow.