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

Abstract

www.clinicaltrials.gov identifier: NCT01041352.

Use of Supraglottic Airway Devices in the Prone Position

“…Three pro-con debate reports were also excluded. A total of 12 articles [8][9][10][11][12][13][14][15][16][17][18][19] were deemed eligible for inclusion in the present review ( Figure 1). …”

“…The remaining 10 articles [10][11][12][13][14][15][16][17][18][19] pertained to the elective use of second-generation SADs in patients in the prone position (Table 1). One study reported the successful use of PLMA by experienced users (not trainee anesthesiologists) in 245 patients in the prone position [10].…”

“…One RCT compared patients in whom PLMA was inserted in the prone position and patients in whom a tracheal tube was placed in the supine position and the patients were turned to the prone position [19]. The authors concluded that the PLMA method was 5 min faster than tracheal intubation (P<0.001), and patients' self-positioning in the prone position before induction saved manpower as well.…”

An update on the prone position: Continuing Professional Development

“…In a recently published randomized-controlled trial comparing induction in the supine position (with endotracheal intubation) vs in the prone position (with insertion of a supraglottic airway [SGA]), the only benefit found was a statistically, albeit not clinically, significant reduction in time to readiness for commencement of surgery (25 min vs 30 min, respectively; P \ 0.001). 12 Potential loss of the airway, limited choices in airway devices and airway maneuvres, and adverse hemodynamics are the major deterrents to the induction of anesthesia in the awake prone patient. 13 On the other hand, patients with an unstable spine may be at risk of further neurological injury while anesthetized during prone positioning.…”

“…Dans une étude randomisée contrôlée publiée récemment qui comparait l'induction en décubitus dorsal (avec intubation endotrachéale) à une induction en position ventrale (avec insertion d'un dispositif supraglottique), le seul avantage observé était une réduction significative, d'un point de vue statistique mais non clinique, du temps jusqu'à ce que le patient soit prêt pour le début de la chirurgie (25 min vs 30 min, respectivement; P \ 0,001). 12 La perte potentielle des voies aériennes, les choix limités en matière de dispositifs et de manoeuvres de prise en charge des voies aériennes, ainsi que les complications hémodynamiques potentielles, sont les points majeurs de dissuasion quand il s'agit d'induire une anesthésie générale en position ventrale. 13 Par contre, les patients dont la colonne vertébrale est instable courent le risque d'une lésion neurologique supplémentaire s'ils sont inconscients pendant le retournement en position ventrale.…”