antiTrendelenburg

Anti-Trendelenburg, commonly called reverse Trendelenburg, is a body position in which a patient lies supine on a table that is tilted so the head is higher than the feet. It is the opposite of the Trendelenburg position, where the head is lower than the feet.

Physiologic effects of the tilt include a decrease in venous return to the heart and a reduction in preload, which can lower intracranial and abdominal pressures. The head-up orientation also generally facilitates diaphragmatic excursion and can improve ventilation, particularly in patients with obesity or upper abdominal pathology. The position is achieved with the table or patient support adjusted to an incline along the long axis of the body, typically in degrees ranging from about 10 to 40, depending on the procedure and patient factors.

Common clinical uses include surgical exposure of the upper abdomen and thoracic structures, such as certain gastric, biliary, liver, thyroid, and neck procedures. In anesthesia and critical care, reverse Trendelenburg may aid airway management and reduce venous congestion in the head and neck, and it is sometimes employed to reduce intracranial pressure when clinically appropriate.

Safety and contraindications: the position is avoided in patients with hemodynamic instability or significant hypovolemia, severe orthostatic intolerance, or certain spinal injuries where stability is compromised. Careful monitoring of blood pressure, heart rate, and airway status is essential, and the tilt should be adjusted gradually with adequate padding and support to prevent nerve or tissue injury.