PRONE  -  Horizontal with horseshoe headrest

DESCRIPTION:
While prone, the head is rested on a horseshoe headrest to facilitate surgical access to the neck or cranium. Used for: Back or neck procedures (cervical) Procedures of the occipital or postero-lateral cranium

POSITIONING STEPS:

1. Note preoperatively, any patient limitations in positioning (neck or arms).  The patient is anesthetized and intubated, and the endotracheal tube is secured, while patient is lying in the supine position, on either a stretcher or bed.  This is accomplished by moving the OR table to one side, so the patient (on stretcher or bed) can be pulled into position for induction, near the anesthesia machine and needed equipment. The OGT, EGS and humidifier should be placed at this time.

2. After intubation and induction are accomplished, the anesthesia provider gives permission for other OR team members to assist in moving the OR table back, next to the stretcher or bed, aligning both in front of the anesthesia machine.  The anesthetist frees and secures all lines ( IV, Art-line, Central-lines, etc.) in preparation for turning of the patient. (Please note: There should be a draw sheet on the OR table before moving patient onto it, for later positioning of the patient arms.)

3. With multiple assistants, the anesthesia circuit is briefly disconnected by the CRNA as he or she simultaneously commands the head, with one hand securing the airway (or ETT), and attends to the position of all lines.  At the command or 1-2-3count of the CRNA, the patient is carefully flipped prone onto the OR table.

4. While other OR team members assist in the prone positioning of the patient, the CRNA continues to maintain the airway, reconnects the circuit, ensures proper functioning of the ventilator (or ability to hand ventilate patient in the case of a LMA), and checks and secures lines.

5. Parallel thoracic or chest rolls (made from tightly rolled sheets and blankets or manufactured gel rolls) are placed under the thorax, lateral to the breasts, following the long line of the body to free the abdomen from compression.  Care is given not to compress the breasts with the rolls or cause undue pressure under the axilla.

6. The anesthetist supports the head while the headboard is removed and a horseshoe headrest is secured to the bed.  The head is then rested on the horseshoe facing the floor, making sure that the eyes, ears, or nose is free from compression, and the c-spine is neutral.

7. The arms are padded and positioned to prevent nerve stretch or compression.  This can be accomplished in a variety of ways depending on the exact nature of the surgery and access required (check with the surgeon).  The arms are secured to prevent accidental dislocation or trauma from movement or falling off of table during the procedure. (See "Arm Positions" section for various placement of prone arms).

8. Legs are maintained in the long axis of the body.  Knees should be padded with egg crate or gel.  Pillows should be placed under the calves and feet to take pressure off the lumbar spine and prevent pressure sores on toes. 

9. The patient is secured to the table with tape or a belt across the thighs immediately under the buttocks.