Anesthesia in Plastic Surgery: Intersurgical I-gel Placement in a Prone Position

Abstract

Anesthesia is a specialization which in past history has branched off of surgery. It needs to be very creative in its delivery, in order to accommodate the many operating positions, needed by the surgeon. The patient positions must also be safe and adequate for proper ventilation, throughout the operative procedure. There are times when multiple positions must be used, turning the patient over, even several times. Careful planning and team discussions prior to an operation are absolutely necessary, to form anesthetic and operative plans. The aim of the supraglottic airway device (Intersurgical i-gel) prone position induction method is to describe, detail and present its safe efficacy for certain planned operative procedures. Patient fasting preparation is a must, nil by mouth for 8 h. This method and sequence alleviates the use of muscle relaxants for patient rotation. This increases patient safety by keeping muscle tone normal, reduced drug use, minimizing rotation of the patient, and reduces possible injury of patient and among staff involved in rotating. Some may say induction in the prone position may be unsafe due to aspiration risks, but knowing anatomy and gravitational physics, in the event of any secretions projected, they will project forwards onto the operating table (through the gastric port of the i-gel), not into the tracheal area. This similar technique and principle are seen and used for the recovery position, to aid in free drainage of fluid from within the oral cavity. The method is used for a variety of operations worldwide and introduced in 2018 at Poliklinika Bagatin (PB). Approximately, 80 prone position inductions or 10% of all general anesthesias are performed every year at PB. More than 240 anesthesized patients in the prone position with an i-gel have used this method, since it was introduced. All have been with excellent results, minimal risk and appropriate ventilation of patients. I-gel placement in prone position was successful everytime. This method is advantageous to avoid multiple rotations of patients and avoid the use of muscle relaxants, otherwise used, with classic endotracheal intubation methods. The exact process will be discussed in more detail and described within the chapter.