Lésions de postures cutanées, ophtalmiques et nerveuses en pédiatrie : comment les éviter ?

Positional injuries are rare but sometimes responsible for major functional sequelae. The imputability of positioning is often entangled with patient's comorbidities and anaesthesia. The pathophysiology of these injuries is directly in relation to the action of gravity and the resulting shear forces. The prevention of mucosal, cutaneous and muscular lesions relies on the maintenance of stable hemodynamics, the prevention of hypothermia, the limitation of the time spent in a risky position and the use of visco-elastic padding gels. The prevention of nerve damage involves the preoperative assessment of comorbidities and the limitation of the duration of positions at risk. The prevention of ocular lesions caused either by compression or direct trauma is based on repeated verification of palpebral occlusion and avoidance of any direct stress to the eyeball during the procedure. Positioning the head in the neutral position, verifying that the head remains above the heart level is recommended in these circumstances, as well as maintenance of normotension and normovolaemia during surgery.