Routine intubation in the prone position

Tracheal intubation in the prone position has previously been reported only as a necessity in a very few emergency situations. It emerged at our clinic as a routine after invention of a test aimed at pinpointing a painful motion segment in patients with chronic low back pain who were candidates for lumbar fusion operation.

During a 6-year period 247 consecutive patients were treated at our clinic, 91 men and 156 women, mean age 42.8 years, range 25.3-62.8. Classification of the pharyngeal structures according to Mallampati et al. was done the day before surgery, and grading of visualization of the glottis as described by Cormack and Lehane was done during intubation, with the aim of revealing factors of importance for the possibility of performing tracheal intubation in the prone position.

The large majority of patients classified preoperatively as Mallampati class 1 had Cormack and Lehane grade 1 at laryngoscopy, although some patients had grades 2, 3, and 4. Most problems with intubation in the prone position were anticipated among those classified preoperatively as Mallampati class 3, but tracheal intubation in the prone position was still possible in 21 of the 23 patients in this group. In all, tracheal intubation in the prone position was successful in 244 of the 247 patients (98.8%).

Routine tracheal intubation in the prone position can be performed effectively by experienced anaesthesiologists, but this requires continuous training and good support from the anaesthesiology staff.