Prone surgery and laryngeal mask airways: an overview of recent studies and personal experience

Abstract

Prone surgery is traditionally performed using endotracheal intubation in the supine position, followed by positioning of the patient in the prone position. This method exposes the patient to the disadvantages of neuromuscular blocking agents which can become problematic for short cases. Positioning of the patient in the prone position also involves a variety of complications. Clinicians tend to avoid the use of a laryngeal mask airway (LMA) in the prone position, but several trials demonstrate its low rate of complication if patient selection is performed properly. Obesity is also demonstrated not to be a contraindication to this anaesthetic technique. Patients are more  haemodynamically stable if induced in the prone position using an LMA rather than supine induction, followed by an endotracheal tube. Although no trial has demonstrated its safety over that of endotracheal intubation, it appears to be a safe alternative to the traditional technique.