2021 Volume 49 Issue 3 Pages 108-110
Oral and maxillofacial surgery is rarely performed with the patient in a prone position, since the risk of serious complications is increased for patients receiving general anesthesia in this position. Here, we report a case of safe general anesthesia management for an obese patient who was atypically treated in a prone position.
A 53-year-old man with a body mass index of 33 kg/m2 had undergone a mandibular resection for the treatment of oral cancer 2 years previously. To improve postoperative oral dysfunction, iliac bone harvesting and bone grafting surgery were planned with the patient in a prone position under general anesthesia. The case was reviewed by the attending dentists, nurses, and medical appliance vendors. The procedure was carefully simulated using a simulated patient in a prone position on the day before the actual surgery. Anesthesia was induced rapidly, and nasotracheal intubation was performed. The patient was placed in the prone position smoothly and was repositioned in the supine position after bone harvesting without any difficulties. While the patient was in the prone position, the cardiac output and stroke volume decreased, but the respiratory and circulatory dynamics were stable throughout the time spent with the patient in a supine position, even during the changing of positions. The patient was extubated once fully awake, and no postoperative complications were reported. Performing surgery with the patient in a prone position often increases the risk of serious complications because of risk factors for complications, limited surgical experience, and unfamiliarity with appliances. In this study, the preoperative simulation was thought to have helped to prevent complications. During respiratory care, low tidal volume ventilation with PEEP is recommended, and it is important to understand the hemodynamics of patients in a prone position. These considerations enable a safer and smoother general anesthesia management.
