An update on the prone position

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.

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.

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).

After reading this module, the anesthesia provider should be able to:

  1. Identify the various types of equipment used in prone positioning, including their indications, advantages, and disadvantages.
  2. Describe the physiological changes associated with prone positioning, especially its effects on the cardiorespiratory system.
  3. Understand the potential complications that can occur with prone positioning and describe techniques to prevent or manage them.
  4. Formulate a strategy for planned extubation after prolonged prone positioning.
  5. Describe the management of an accidental extubation during prone positioning.
  6. Discuss strategies to improve the safety of patients undergoing surgery in the prone position.

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