Which surgical position will contribute to decreased venous return and hypotension when the legs are rapidly lowered?

Choosing the lithotomy position can lead to decreased venous return and hypotension when the legs are rapidly lowered due to the effects of vascular changes and gravity. In the lithotomy position, the patient's legs are elevated and often in a supported position. When the legs are then suddenly lowered, there is a significant shift in blood volume within the venous system. This rapid transition can cause blood to pool in the lower extremities, leading to reduced venous return to the heart and subsequent hypotension.

In contrast, the sitting position typically improves venous return because it keeps the legs and lower body in a more upright position, which prevents pooling. The supine position maintains a neutral alignment of the body, and Trendelenburg, where the legs are elevated, often increases venous return due to the elevated pelvis and legs, enhancing venous return to the heart.