Anaesthesia and the Prone Position: A Case Report and Review of Literature

The patient was a 14year old boy with a diagnosis of posterior cranial fossa tumour scheduled for suboccipital craniectomy and supratentorial craniotomy. Under general anaesthesia, with relaxant technique and mechanical ventilation, the tumour was excised in a prone head-up position. Intraoperative, the patient was closely monitored with a pulse oximeter, non-invasive blood pressure monitor, a 5-lead ECG, an end-tidal carbon dioxide monitor, and a urinary catheter. The patient was moderately hyperventilated to an end tidal carbon dioxide (ETCO₂) of between 3.7-4.2kPa throughout surgery and transfused 2units of whole blood. 2 While no direct complication of the prone position was noted throughout the duration of this surgery, intraoperative complications included fluctuations in blood pressure and episodes of tachyarrhythmia that needed no direct interventions. Neuroanaesthesia in the prone position will continuously remain a challenge to the anaesthetist,not only because of this abnormal position, but also the physiological changes occasioned by this position.