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Erschienen in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie 6/2016

12.04.2016 | Continuing Professional Development

An update on the prone position: Continuing Professional Development

verfasst von: Jason Chui, MBChB, Rosemary Ann Craen, MBBS

Erschienen in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Ausgabe 6/2016

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Abstract

Purpose

The purpose of this Continuing Professional Development module is to provide information needed to prepare for and clinically manage a patient in the prone position.

Principal findings

Prone positioning is required for surgical procedures that involve the posterior aspect of a patient. We searched MEDLINE® and EMBASE™ from January 2000 to January 2015 for literature related to the prone position and retrieved only original articles in English. We reviewed the advantages and disadvantages of various equipment used in prone positioning, the physiological changes associated with prone positioning, and the complications that can occur. We also reviewed strategies for the safe conduct and management of position-related complications.

Conclusion

Increased age, elevated body mass index, the presence of comorbidities, and long duration of surgery appear to be the most important risk factors for complications associated with prone positioning. We recommend a structured team approach and careful selection of equipment tailored to the patient and surgery. The systematic use of checklists is recommended to guide operating room teams and to reduce prone position-related complications. Anesthesiologists should be prepared to manage major intraoperative emergencies (e.g., accidental extubation) and anticipate postoperative complications (e.g., airway edema and visual loss).
Literatur
1.
Zurück zum Zitat Edgcombe H, Carter K, Yarrow S. Anaesthesia in the prone position. Br J Anaesth 2008; 100: 165-83. Edgcombe H, Carter K, Yarrow S. Anaesthesia in the prone position. Br J Anaesth 2008; 100: 165-83.
2.
Zurück zum Zitat Nyren SR, Radell P, Lindahl SG, et al. Lung ventilation and perfusion in prone and supine postures with reference to anesthetized and mechanically ventilated healthy volunteers. Anesthesiology 2010; 112: 682-7.CrossRefPubMed Nyren SR, Radell P, Lindahl SG, et al. Lung ventilation and perfusion in prone and supine postures with reference to anesthetized and mechanically ventilated healthy volunteers. Anesthesiology 2010; 112: 682-7.CrossRefPubMed
3.
Zurück zum Zitat Petersson J, Ax M, Frey J, Sanchez-Crespo A, Lindahl SG, Mure M. Positive end-expiratory pressure redistributes regional blood flow and ventilation differently in supine and prone humans. Anesthesiology 2010; 113: 1361-9.CrossRefPubMed Petersson J, Ax M, Frey J, Sanchez-Crespo A, Lindahl SG, Mure M. Positive end-expiratory pressure redistributes regional blood flow and ventilation differently in supine and prone humans. Anesthesiology 2010; 113: 1361-9.CrossRefPubMed
4.
Zurück zum Zitat Guerin C, Baboi L, Richard JC. Mechanisms of the effects of prone positioning in acute respiratory distress syndrome. Intensive Care Med 2014; 40: 1634-42.CrossRefPubMed Guerin C, Baboi L, Richard JC. Mechanisms of the effects of prone positioning in acute respiratory distress syndrome. Intensive Care Med 2014; 40: 1634-42.CrossRefPubMed
5.
Zurück zum Zitat Guerin C, Reignier J, Richard JC, et al. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med 2013; 368: 2159-68.CrossRefPubMed Guerin C, Reignier J, Richard JC, et al. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med 2013; 368: 2159-68.CrossRefPubMed
6.
Zurück zum Zitat Pelosi P, Croci M, Calappi E, et al. The prone positioning during general anesthesia minimally affects respiratory mechanics while improving functional residual capacity and increasing oxygen tension. Anesth Analg 1995; 80: 955-60.PubMed Pelosi P, Croci M, Calappi E, et al. The prone positioning during general anesthesia minimally affects respiratory mechanics while improving functional residual capacity and increasing oxygen tension. Anesth Analg 1995; 80: 955-60.PubMed
7.
Zurück zum Zitat Toyota S, Amaki Y. Hemodynamic evaluation of the prone position by transesophageal echocardiography. J Clin Anesth 1998; 10: 32-5.CrossRefPubMed Toyota S, Amaki Y. Hemodynamic evaluation of the prone position by transesophageal echocardiography. J Clin Anesth 1998; 10: 32-5.CrossRefPubMed
8.
Zurück zum Zitat Dharmavaram S, Jellish WS, Nockels RP, et al. Effect of prone positioning systems on hemodynamic and cardiac function during lumbar spine surgery: an echocardiographic study. Spine (Phila Pa 1976) 2006; 31: 1388-93; discussion 94. Dharmavaram S, Jellish WS, Nockels RP, et al. Effect of prone positioning systems on hemodynamic and cardiac function during lumbar spine surgery: an echocardiographic study. Spine (Phila Pa 1976) 2006; 31: 1388-93; discussion 94.
9.
Zurück zum Zitat Shimizu M, Fujii H, Yamawake N, Nishizaki M. Cardiac function changes with switching from the supine to prone position: analysis by quantitative semiconductor gated single-photon emission computed tomography. J Nucl Cardiol 2015; 22: 301-7.CrossRefPubMed Shimizu M, Fujii H, Yamawake N, Nishizaki M. Cardiac function changes with switching from the supine to prone position: analysis by quantitative semiconductor gated single-photon emission computed tomography. J Nucl Cardiol 2015; 22: 301-7.CrossRefPubMed
10.
Zurück zum Zitat Ideno S, Yamada T, Takeda J. Anesthetic management of a patient with severe aortic stenosis undergoing spine surgery (Japanese). Masui 2013; 62: 721-3.PubMed Ideno S, Yamada T, Takeda J. Anesthetic management of a patient with severe aortic stenosis undergoing spine surgery (Japanese). Masui 2013; 62: 721-3.PubMed
11.
Zurück zum Zitat Chacon MM, Hattrup EA, Shillcutt SK. Perioperative management of two patients with left ventricular assist devices presenting for noncardiac surgery in the prone position. A A Case Rep 2014; 2: 70-3.CrossRefPubMed Chacon MM, Hattrup EA, Shillcutt SK. Perioperative management of two patients with left ventricular assist devices presenting for noncardiac surgery in the prone position. A A Case Rep 2014; 2: 70-3.CrossRefPubMed
12.
Zurück zum Zitat Olsen KS, Petersen JT, Pedersen NA, Rovsing L. Self-positioning followed by induction of anaesthesia and insertion of a laryngeal mask airway versus endotracheal intubation and subsequent positioning for spinal surgery in the prone position: a randomised clinical trial. Eur J Anaesthesiol 2014; 31: 259-65.CrossRefPubMed Olsen KS, Petersen JT, Pedersen NA, Rovsing L. Self-positioning followed by induction of anaesthesia and insertion of a laryngeal mask airway versus endotracheal intubation and subsequent positioning for spinal surgery in the prone position: a randomised clinical trial. Eur J Anaesthesiol 2014; 31: 259-65.CrossRefPubMed
13.
Zurück zum Zitat Ellard L, Wong DT. Should we induce general anesthesia in the prone position? Curr Opin Anaesthesiol 2014; 27: 635-42.CrossRefPubMed Ellard L, Wong DT. Should we induce general anesthesia in the prone position? Curr Opin Anaesthesiol 2014; 27: 635-42.CrossRefPubMed
14.
Zurück zum Zitat Malcharek MJ, Rogos B, Watzlawek S, et al. Awake fiberoptic intubation and self-positioning in patients at risk of secondary cervical injury: a pilot study. J Neurosurg Anesthesiol 2012; 24: 217-21.CrossRefPubMed Malcharek MJ, Rogos B, Watzlawek S, et al. Awake fiberoptic intubation and self-positioning in patients at risk of secondary cervical injury: a pilot study. J Neurosurg Anesthesiol 2012; 24: 217-21.CrossRefPubMed
15.
Zurück zum Zitat Douglass J, Fraser J, Andrzejowski J. Awake intubation and awake prone positioning of a morbidly obese patient for lumbar spine surgery. Anaesthesia 2014; 69: 166-9.CrossRefPubMed Douglass J, Fraser J, Andrzejowski J. Awake intubation and awake prone positioning of a morbidly obese patient for lumbar spine surgery. Anaesthesia 2014; 69: 166-9.CrossRefPubMed
16.
Zurück zum Zitat Tsaousi G, Karakoulas K, Nouris C, Mitos G, Vasilakos D. Effect of prone positioning with thoraco-pelvic supports on respiratory mechanics during spine surgery: 5AP4-3. Eur J Anaesthesiol 2012; 29: 89.CrossRef Tsaousi G, Karakoulas K, Nouris C, Mitos G, Vasilakos D. Effect of prone positioning with thoraco-pelvic supports on respiratory mechanics during spine surgery: 5AP4-3. Eur J Anaesthesiol 2012; 29: 89.CrossRef
17.
Zurück zum Zitat Jo YY, Kim JY, Kwak YL, Kim YB, Kwak HJ. The effect of pressure-controlled ventilation on pulmonary mechanics in the prone position during posterior lumbar spine surgery: a comparison with volume-controlled ventilation. J Neurosurg Anesthesiol 2012; 24: 14-8.CrossRefPubMed Jo YY, Kim JY, Kwak YL, Kim YB, Kwak HJ. The effect of pressure-controlled ventilation on pulmonary mechanics in the prone position during posterior lumbar spine surgery: a comparison with volume-controlled ventilation. J Neurosurg Anesthesiol 2012; 24: 14-8.CrossRefPubMed
18.
Zurück zum Zitat Yokoyama M, Ueda W, Hirakawa M, Yamamoto H. Hemodynamic effect of the prone position during anesthesa. Acta Anaesthesiol Scand 1991; 35: 741-4.CrossRefPubMed Yokoyama M, Ueda W, Hirakawa M, Yamamoto H. Hemodynamic effect of the prone position during anesthesa. Acta Anaesthesiol Scand 1991; 35: 741-4.CrossRefPubMed
19.
Zurück zum Zitat Merchant R, Chartrand D, Dain S, et al. Guidelines to the practice of anesthesia—revised edition 2016. Can J Anesth 2016; 63: 86-112.CrossRefPubMed Merchant R, Chartrand D, Dain S, et al. Guidelines to the practice of anesthesia—revised edition 2016. Can J Anesth 2016; 63: 86-112.CrossRefPubMed
20.
Zurück zum Zitat Biais M, Bernard O, Ha JC, Degryse C, Sztark F. Abilities of pulse pressure variations and stroke volume variations to predict fluid responsiveness in prone position during scoliosis surgery. Br J Anaesth 2010; 104: 407-13.CrossRefPubMed Biais M, Bernard O, Ha JC, Degryse C, Sztark F. Abilities of pulse pressure variations and stroke volume variations to predict fluid responsiveness in prone position during scoliosis surgery. Br J Anaesth 2010; 104: 407-13.CrossRefPubMed
21.
Zurück zum Zitat Wu CY, Lee TS, Chan KC, Jeng CS, Cheng YJ. Does targeted pre-load optimisation by stroke volume variation attenuate a reduction in cardiac output in the prone position. Anaesthesia 2012; 67: 760-4.CrossRefPubMed Wu CY, Lee TS, Chan KC, Jeng CS, Cheng YJ. Does targeted pre-load optimisation by stroke volume variation attenuate a reduction in cardiac output in the prone position. Anaesthesia 2012; 67: 760-4.CrossRefPubMed
22.
Zurück zum Zitat Sudheer PS, Logan SW, Ateleanu B, Hall JE. Haemodynamic effects of the prone position: a comparison of propofol total intravenous and inhalation anaesthesia. Anaesthesia 2006; 61: 138-41.CrossRefPubMed Sudheer PS, Logan SW, Ateleanu B, Hall JE. Haemodynamic effects of the prone position: a comparison of propofol total intravenous and inhalation anaesthesia. Anaesthesia 2006; 61: 138-41.CrossRefPubMed
23.
Zurück zum Zitat Wattenmaker I, Conception M, Hibberd P, Lipson S. Upper-airway obstruction and perioperative management of the airway in patients managed with posterior operations on the cervical spine for rheumatoid arthritis. J Bone Joint Surg Am 1994; 76: 360-5.PubMed Wattenmaker I, Conception M, Hibberd P, Lipson S. Upper-airway obstruction and perioperative management of the airway in patients managed with posterior operations on the cervical spine for rheumatoid arthritis. J Bone Joint Surg Am 1994; 76: 360-5.PubMed
24.
Zurück zum Zitat Sinha A, Agarwal A, Gaur A, Pandey CK. Oropharyngeal swelling and macroglossia after cervical spine surgery in the prone position. J Neurosurg Anesthesiol 2001; 13: 237-9.CrossRefPubMed Sinha A, Agarwal A, Gaur A, Pandey CK. Oropharyngeal swelling and macroglossia after cervical spine surgery in the prone position. J Neurosurg Anesthesiol 2001; 13: 237-9.CrossRefPubMed
25.
Zurück zum Zitat Morita M, Nobuta M, Naruse H, Nakamura H. Prolonged airway obstruction after posterior occipitocervical fusion: a case report and literature review. Adv Orthop 2011; 2011: 791923.CrossRefPubMedPubMedCentral Morita M, Nobuta M, Naruse H, Nakamura H. Prolonged airway obstruction after posterior occipitocervical fusion: a case report and literature review. Adv Orthop 2011; 2011: 791923.CrossRefPubMedPubMedCentral
26.
Zurück zum Zitat Cavallone LF, Vannucci A. Review article: Extubation of the difficult airway and extubation failure. Anesth Analg 2013; 116: 368-83.CrossRefPubMed Cavallone LF, Vannucci A. Review article: Extubation of the difficult airway and extubation failure. Anesth Analg 2013; 116: 368-83.CrossRefPubMed
27.
Zurück zum Zitat Difficult Airway Society Extubation Guidelines Group, Popat M, Mitchell V, et al. Difficult Airway Society Guidelines for the management of tracheal extubation. Anaesthesia 2012; 67: 318-40.CrossRef Difficult Airway Society Extubation Guidelines Group, Popat M, Mitchell V, et al. Difficult Airway Society Guidelines for the management of tracheal extubation. Anaesthesia 2012; 67: 318-40.CrossRef
28.
Zurück zum Zitat Cata JP, Saager L, Kurz A, Avitsian R. Successful extubation in the operating room after infratentorial craniotomy: the Cleveland Clinic experience. J Neurosurg Anesthesiol 2011; 23: 25-9.CrossRefPubMed Cata JP, Saager L, Kurz A, Avitsian R. Successful extubation in the operating room after infratentorial craniotomy: the Cleveland Clinic experience. J Neurosurg Anesthesiol 2011; 23: 25-9.CrossRefPubMed
29.
Zurück zum Zitat Mazer SP, Weisfeldt M, Bai D, et al. Reverse CPR: a pilot study of CPR in the prone position. Resuscitation 2003; 57: 279-85.CrossRefPubMed Mazer SP, Weisfeldt M, Bai D, et al. Reverse CPR: a pilot study of CPR in the prone position. Resuscitation 2003; 57: 279-85.CrossRefPubMed
30.
Zurück zum Zitat Haffner E, Sostarich AM, Fosel T. Successful cardiopulmonary resuscitation in prone position (German). Anaesthesist 2010; 59: 1099-101.CrossRefPubMed Haffner E, Sostarich AM, Fosel T. Successful cardiopulmonary resuscitation in prone position (German). Anaesthesist 2010; 59: 1099-101.CrossRefPubMed
31.
Zurück zum Zitat Tobias JD, Mencio GA, Atwood R, Gurwitz GS. Intraoperative cardiopulmonary resuscitation in the prone position. J Pediatr Surg 1994; 29: 1537-8.CrossRefPubMed Tobias JD, Mencio GA, Atwood R, Gurwitz GS. Intraoperative cardiopulmonary resuscitation in the prone position. J Pediatr Surg 1994; 29: 1537-8.CrossRefPubMed
32.
Zurück zum Zitat Dequin PF, Hazouard E, Legras A, Lanotte R, Perrotin D. Cardiopulmonary resuscitation in the prone position: Kouwenhoven revisited. Intensive Care Med 1996; 22: 1272.CrossRefPubMed Dequin PF, Hazouard E, Legras A, Lanotte R, Perrotin D. Cardiopulmonary resuscitation in the prone position: Kouwenhoven revisited. Intensive Care Med 1996; 22: 1272.CrossRefPubMed
33.
Zurück zum Zitat Lam AM, Vavilala M. Macroglossia: compartment syndrome of the tongue? Anesthesiology 2000; 92: 1832-5.CrossRefPubMed Lam AM, Vavilala M. Macroglossia: compartment syndrome of the tongue? Anesthesiology 2000; 92: 1832-5.CrossRefPubMed
34.
Zurück zum Zitat Abrishami A, Zilberman P, Chung F. Brief review: Airway rescue with insertion of laryngeal mask airway devices with patients in the prone position. Can J Anesth 2010; 57: 1014-20.CrossRefPubMed Abrishami A, Zilberman P, Chung F. Brief review: Airway rescue with insertion of laryngeal mask airway devices with patients in the prone position. Can J Anesth 2010; 57: 1014-20.CrossRefPubMed
35.
Zurück zum Zitat Lopez AM, Valero R, Hurtado P, Gambs P, Pons M, Anglada T. Comparison of the LMA Supreme™ with the LMA Proseal™ for airway management in patients anaesthetized in prone position. Br J Anaesth 2011; 107: 265-71.CrossRefPubMed Lopez AM, Valero R, Hurtado P, Gambs P, Pons M, Anglada T. Comparison of the LMA Supreme™ with the LMA Proseal™ for airway management in patients anaesthetized in prone position. Br J Anaesth 2011; 107: 265-71.CrossRefPubMed
36.
37.
38.
Zurück zum Zitat Kamel IR, Drum ET, Koch SA, et al. The use of somatosensory evoked potentials to determine the relationship between patient positioning and impending upper extremity nerve injury during spine surgery: a retrospective analysis. Anesth Analg 2006; 102: 1538-42.CrossRefPubMed Kamel IR, Drum ET, Koch SA, et al. The use of somatosensory evoked potentials to determine the relationship between patient positioning and impending upper extremity nerve injury during spine surgery: a retrospective analysis. Anesth Analg 2006; 102: 1538-42.CrossRefPubMed
39.
Zurück zum Zitat Biousse V, Newman NJ. Ischemic optic neuropathies. N Engl J Med 2015; 372: 2428-36. Biousse V, Newman NJ. Ischemic optic neuropathies. N Engl J Med 2015; 372: 2428-36.
40.
Zurück zum Zitat Shen Y, Drum M, Roth S. The prevalence of perioperative visual loss in the United States: a 10-year study from 1996 to 2005 of spinal, orthopedic, cardiac, and general surgery. Anesth Analg 2009; 109: 1534-45.CrossRefPubMed Shen Y, Drum M, Roth S. The prevalence of perioperative visual loss in the United States: a 10-year study from 1996 to 2005 of spinal, orthopedic, cardiac, and general surgery. Anesth Analg 2009; 109: 1534-45.CrossRefPubMed
42.
Zurück zum Zitat Chang SH, Miller NR. The incidence of vision loss due to perioperative ischemic optic neuropathy associated with spine surgery: the Johns Hopkins Hospital Experience. Spine 2005; 30: 1299-302.CrossRefPubMed Chang SH, Miller NR. The incidence of vision loss due to perioperative ischemic optic neuropathy associated with spine surgery: the Johns Hopkins Hospital Experience. Spine 2005; 30: 1299-302.CrossRefPubMed
43.
Zurück zum Zitat Stevens WR, Glazer PA, Kelley SD, Lietman TM, Bradford DS. Ophthalmic complications after spinal surgery. Spine 1997; 22: 1319-24.CrossRefPubMed Stevens WR, Glazer PA, Kelley SD, Lietman TM, Bradford DS. Ophthalmic complications after spinal surgery. Spine 1997; 22: 1319-24.CrossRefPubMed
44.
Zurück zum Zitat Lee LA, Roth S, Posner KL, et al. The American Society of Anesthesiologists Postoperative Visual Loss Registry: analysis of 93 spine surgery cases with postoperative visual loss. Anesthesiology 2006; 105: 652-9.CrossRefPubMed Lee LA, Roth S, Posner KL, et al. The American Society of Anesthesiologists Postoperative Visual Loss Registry: analysis of 93 spine surgery cases with postoperative visual loss. Anesthesiology 2006; 105: 652-9.CrossRefPubMed
45.
Zurück zum Zitat Lee LA, Newman NJ, Wagner TA, Dettori JR, Dettori NJ. Postoperative ischemic optic neuropathy. Spine (Phila Pa 1976) 2010; 35: S105-16. Lee LA, Newman NJ, Wagner TA, Dettori JR, Dettori NJ. Postoperative ischemic optic neuropathy. Spine (Phila Pa 1976) 2010; 35: S105-16.
46.
Zurück zum Zitat Postoperative Visual Loss Study Group. Risk factors associated with ischemic optic neuropathy after spinal fusion surgery. Anesthesiology 2012; 116: 15-24. Postoperative Visual Loss Study Group. Risk factors associated with ischemic optic neuropathy after spinal fusion surgery. Anesthesiology 2012; 116: 15-24.
47.
Zurück zum Zitat Salkind EM. A novel approach to improving the safety of patients undergoing lumbar laminectomy. AANA J 2013; 81: 389-93.PubMed Salkind EM. A novel approach to improving the safety of patients undergoing lumbar laminectomy. AANA J 2013; 81: 389-93.PubMed
48.
Zurück zum Zitat Nguyen-Lu N, Reddy U, Luoma A. To prone or, not to prone? What are we telling our patients? An audit on documentation of consent for prone positioning during neurosurgery. J Neurosurg Anesthesiol 2012; 24: 495 (abstract). Nguyen-Lu N, Reddy U, Luoma A. To prone or, not to prone? What are we telling our patients? An audit on documentation of consent for prone positioning during neurosurgery. J Neurosurg Anesthesiol 2012; 24: 495 (abstract).
49.
Zurück zum Zitat Smith M, Klepsch P. Consent for prone positioning-a project. Anaesthesia 2014; 69: 205 (abstract). Smith M, Klepsch P. Consent for prone positioning-a project. Anaesthesia 2014; 69: 205 (abstract).
Metadaten
Titel
An update on the prone position: Continuing Professional Development
verfasst von
Jason Chui, MBChB
Rosemary Ann Craen, MBBS
Publikationsdatum
12.04.2016
Verlag
Springer US
Erschienen in
Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Ausgabe 6/2016
Print ISSN: 0832-610X
Elektronische ISSN: 1496-8975
DOI
https://doi.org/10.1007/s12630-016-0634-x

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