Trendelenburg position

Last revised by Frank Gaillard on 25 Dec 2023

The Trendelenberg position is used in various interventional and diagnostic procedures whereby the patient is placed supine with the pelvis and lower limbs elevated above the head, typically 15-30°.

A reverse Trendelenburg position, as the name implies, is merely a similar degree of feet-down, head up.

Both positions are usually achieved by mechanical tilting of the bed, surgical table or fluoroscopy gantry. When unavailable, this can be achieved by using foam wedges or other props placed between a horizontal surface and the patient.

Physiological effects

The Trendelenberg position does not merely have a geometric advantage (e.g. allowing better access to the perineum; enabling contrast to run down the thecal sac in dynamic CT myelography), but also has numerous physiological effects including 2:

  • increased central blood volume

  • increased mean arterial pressure

  • increased cardiac output (transient, returns to normal after 10 minutes)

  • increase in central venous pressure

  • decrease in aortic diameter (minor)

  • increased systemic vascular resistance

Furthermore, if prolonged, several deleterious effects may ensue, including 2,3:

  • respiratory compromise, particularly in obese patients undergoing laparoscopic pelvic surgery with pneumoperitoneum

  • ischemic optic neuropathy (usually in the setting of steep Trendelenberg positioning)

  • upper airway and facial edema

History and etymology

Trendelenberg position is named after Friedrich Trendelenburg (1844-1924), German surgeon, who popularized the postion, although by no means invented it. There is ample evidence of the widespread use to head-down pelvis-up position for pelvic surgery, particularly lithotomy for bladder stones (dating back to the first centrur CE) and hernia repair (dating back to the 16th centruy)1.

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