Postoperative blindness is increasing in frequency, but it is unclear exactly which patients are at risk. All articulating supports must be fully locked as failure of this bracketing device may lead to complications if the head suddenly drops.Ī conscientious attitude toward positioning is required to facilitate the surgical procedure, prevent physiologic embarrassment, and prevent injury to the patient. Both horseshoe and pin headrests attach to the operating room table with adjustable articulating supports. Patient movement must be prevented when the head is held in pins movement in pins can result in scalp lacerations or a cervical spine injury. Pin fixation, which is most used in cranial and cervical surgery, is advantageous because there is no direct pressure on the face ( Fig. The forehead and malar regions are supported by the horseshoe headrest and allow for reasonable access to the airway ( Figs. Most pillows support the forehead, malar regions, and chin, with a cutout for the eyes, nose, and mouth (see Fig. Several commercially available pillows are specially designed for the prone position. Mirror systems are available to facilitate intermittent visual confirmation that the eyes are not compressed, although direct visualization or tactile confirmation is prudent ( Fig. Weight should be on the bony facial prominences and not soft tissue and especially not on the eyes. During general anesthesia, the head is usually kept neutral using a surgical pillow, horseshoe headrest, or head pins. For patients under sedation, the head may be turned to the side if neck mobility is adequate. Ventilation and monitoring should be reestablished as rapidly as possible. Lines and monitors connected to the inside arm (the arm moving the least during the move) can often be easily maintained without disconnecting. Which, and how many, monitors and lines are disconnected during the move is up to the clinical judgement of the anesthesiologist for an individual patient. The endotracheal tube should be disconnected from the circuit during the move from supine to prone in order to prevent dislodgement. An exception might be the patient in whom rigid pin fixation is used when the surgeon often holds the pin frame. The anesthesiologist is primarily responsible for coordinating the move while maintaining inline stabilization of the cervical spine and monitoring the endotracheal tube. Placing an anesthetized patient in the prone position requires the coordination of the entire surgical staff. Special attention should be paid to securing and taping the endotracheal tube to prevent dislodgement while the patient is prone or during changes in position. When general anesthesia is planned, the airway is usually secured via an endotracheal tube while the patient is still supine. The patient may receive either monitored anesthesia care or general anesthesia depending on the type of surgery and the patient’s body habitus and comorbidities. 34.15) is primarily used for surgical access to the posterior fossa of the skull, the posterior spine, the buttocks and perirectal area, and the posterior lower extremities. The prone or ventral decubitus position ( Fig. Gropper MD, PhD, in Miller's Anesthesia, 2020 Prone
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