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New in CJA: Dr. Jason Chui and Dr. Rosemary Craen present a Continuing Professional Development module in prone positioning

Can J Anaesth. 2016 Apr 12. [Epub ahead of print]


An update on the prone position: Continuing Professional Development

Chui JCraen RA.

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).

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