A foam-cushion face mask and a see-through operation table: a new set-up for face protection and increased safety in prone position
Muenster, Germany
* E-mail: manuelwenk{at}uni-muenster.de
Editor—Positioning the head of patients undergoing procedures in prone position is crucial and remains a difficult task for the anaesthesiologist.1 Often, it is a compromise between a normal position of the head without derogating facial and neck tissues on the one hand and sufficient control over airway devices on the other hand. Most reported sequelae associated with prone positioning are due to unnoticed pressure on the head and neck region and range from mild irritation2 3 to disastrous complications, such as corneal abrasion,4 central retinal artery occlusion leading to impaired vision,5 6 or even stroke due to neck torsion-induced vertebral artery occlusion.1 We believe that the main problem in head positioning is based on the fact that we, as anaesthetists, try to fit the patient's face into the available support cushions and not the cushion onto the patient's face, which would allow complete control over head position. Therefore, we developed a technique using a commercially available foam-based boxing helmet that is fitted to the patient before turning to the prone position and guarantees that the face and eyes are free from pressure (Fig. 1). The helmet also keeps the neck in a straight line without forcing it into tilting or turning positions, thus avoiding compression or torsion of vessels and nerves, although all airway devices remain accessible and safe. To be able to control pressure on soft tissue structures and to supervise airway devices, we use an operating table with a clear plastic window in the head and neck region. A mirror mounted underneath allows the anaesthetist to see the position of face and airway devices at all times (Fig. 2). We believe that the combination of a face mask and positioning on the see-through table may be a sensible and cost-effective yet simple approach to reduce positioning-associated side-effects and increase safety during prone position procedures.
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References
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3 Jackson L, Keats AS. Mechanism of brachial plexus palsy following anesthesia. Anesthesiology (1965) 26:190–4.[Web of Science][Medline]
4 Stambough JL, Dolan D, Werner R, Godfrey E. Ophthalmologic complications associated with prone positioning in spine surgery. J Am Acad Orthop Surg (2007) 15:156–65.
5 Lee LA, Roth S, Posner KL, et al. The American Society of Anesthesiologists Postoperative Visual Loss Registry: analysis of 93 spine surgery cases with postoperative visual loss. Anesthesiology (2006) 105:652–9.[CrossRef][Web of Science][Medline]
6 Zahn PK, Wenk MJ, Pogatzki-Zahn EM, Busse H, Van Aken H. Postoperative blindness—a rare but devastating complication. Eur J Anaesthesiol (2007) 24:96–7.[CrossRef][Web of Science][Medline]
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