Prone Pozisyonda Havayolu Yönetimi
Özet
Prone (yüzüstü) pozisyon, özellikle spinal cerrahiler ve posterior bölge operasyonlarında cerrahi erişim sağlamak amacıyla 1930'lardan beri yaygın olarak kullanılmaktadır. Bu pozisyon, supin pozisyona kıyasla ventilasyon ve perfüzyon uyumunu artırarak arteryel oksijenizasyonu iyileştirebilir; ancak yüksek PEEP uygulamaları bu dengeyi bozabilir. Fizyolojik olarak kalp indeksinde %10-20 oranında hafif bir azalma gözlense de sağlıklı hastalarda bu durum kompanse edilir. Yine de düşük kardiyak rezervi olan veya obez hastalar hemodinamik açıdan risk altındadır ve invazif takipleri önerilir. Hava yolu yönetiminde geleneksel yöntem supin pozisyonda entübasyon ve ardından hastanın döndürülmesidir. Ancak deneyimli ellerde ve seçilmiş vakalarda, Prone pozisyonunda indüksiyon ve Laringeal Maske (LMA) kullanımı başarıyla uygulanabilmektedir. Postoperatif dönemde ise makroglossi ve laringeal ödem gibi komplikasyonlar nedeniyle ekstübasyon planlaması titizlikle yapılmalıdır. Prone pozisyonda meydana gelebilecek kazara ekstübasyonlar, sınırlı erişim nedeniyle "zor hava yolu" senaryosu olarak kabul edilir. Bu gibi acil durumlarda hastanın hızla supin pozisyona çevrilmesi veya Prone pozisyonunda İLMA (Fastrack, Air-Q) gibi supraglottik araçlarla hava yolunun kurtarılması hayati önem taşır.
The prone position has been widely used since the 1930s to provide surgical access for spinal surgeries and posterior region operations. Compared to the supine position, the prone position can improve arterial oxygenation by enhancing the ventilation-perfusion match; however, high PEEP applications may disrupt this balance. Physiologically, a slight decrease of 10-20% in the cardiac index is observed, which is compensated for in healthy patients. Nevertheless, patients with low cardiac reserve or obesity are at hemodynamic risk and require invasive monitoring. In airway management, the traditional method involves intubation in the supine position followed by turning the patient. However, in experienced hands and selected cases, induction and the use of a Laryngeal Mask Airway (LMA) in the prone position can be successfully implemented. In the postoperative period, extubation planning must be performed meticulously due to complications such as macroglossia and laryngeal edema. Accidental extubations occurring in the prone position are considered "difficult airway" scenarios due to limited access. In such emergencies, it is vital to quickly turn the patient to the supine position or rescue the airway using supraglottic devices like ILMA (Fastrack, Air-Q) while in the prone position.
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