Awake Endotracheal Intubation and Prone Patient Self-Positioning: Anesthetic and Positioning Considerations During Percutaneous Nephrolithotomy in Obese Patients

Abstract

The technique of awake intubation with prone patient self-positioning can be helpful for positioning morbidly obese patients before PCNL and has been safe and effective in properly selected patients. Efficacy of PCNL should not be impacted by obesity or prone positioning and morbidity minimized provided that surgical and anesthesia teams understand and safeguard against potential complications.

Percutaneous Nephrolithotomy in Obese Patients: Comparison Between the Prone and Total Supine Position

“…Physical strength from the operating room staff is needed; the risk of orotracheal intubation loss and peripheral nerve lesion is a reality even with great care by the anesthesiologist. 29 A shorter hospital stay contributes to reducing costs. This way, the supine position offers a great advantage over the prone position concerning these two aspects.…”

The clinical research office of the endourological society percutaneous nephrolithotomy global study: Outcomes in the morbidly obese patient – a case control analysis

“…A number of investigators have proposed strategies to reduce risk including supine and lateral decubitus positioning, the use of conscious sedation, awake endotracheal intubation and prone patient self positioning. [18][19][20][21][22][23][24] Despite the findings of Manohar and colleagues, 25 who suggested supine PCNL is safe and effective for morbidly obese patients, the results of the current study suggest that supine positioning was utilized significantly less often in the obese cohort (18.6 vs. 34.0%).…”

Urological Surgical Procedures Under Local Anesthesia

“…The other complicating factor particularly in obese patients is tube displacement, nerve compression, etc during prone positioning following intubation. Wu and colleagues (Wu et al, 2009) described a technique of awake intubation and prone patient self-positioning before PCNL. They reported that the technique of awake intubation with prone patient self-positioning can be helpful for positioning morbidly obese patients before PCNL and has been safe and effective in properly selected patients.…”

“…They reported that the technique of awake intubation with prone patient self-positioning can be helpful for positioning morbidly obese patients before PCNL and has been safe and effective in properly selected patients. Obesity or prone positioning should not impact efficacy of PCNL and morbidity minimized provided that surgical and anesthesia teams understand and safeguard against potential complications (Wu et al, 2009). In another interesting work Aravantinos and colleagues (Aravantinos et al, 2009) used multimodal anesthesia in order to avoid complications related to general anesthesia.…”