title: Ventilation with facial mask in the prone position for radiotherapy procedures in children.
abstract: OBJECTIVE
  Ventilation of patients undergoing procedures in the prone position represents a challenge for the anesthesiologist, especially when trying to avoid tracheal intubation. This study aimed to test the effectiveness and safety of a prototype designed for pediatric facial mask ventilation in the prone position.
  
  
  METHODS
  A prospective descriptive study was conducted on 105 sedations performed in 3 children scheduled for radiotherapy treatment of posterior fossa desmoplastic medulloblastoma (6 and 4 y.o. males), and neuroblastoma in temporal area (4 y.o. male). Induction and maintenance of sedation were conducted with sevoflurane in oxygen, maintaining spontaneous ventilation. After achieving loss of consciousness and immobility, the patients were placed in the prone position. Their heads were fixed with the forehead and face supported by a prototype made with a cast of expanded polystyrene (EPS), which held the facial mask (connected to a Mapleson D circuit), and the back of the head immobilized with a layer of thermoplastic material. Time variables and complications were recorded.
  
  
  RESULTS
  All sedations were performed according to the planned protocol. All patients maintained oxygen saturation levels above 95%, and no complications were reported. Daily hospital length of stay including the procedure and post anesthetic recovery was 54.4±7.9 min (mean±SD).
  
  
  CONCLUSIONS
  The prototype and the sedation technique with face mask in the prone position employed were effective and safe, allowing the completion of the radiotherapy sessions and securing the airway in a minimally invasive way, maintaining adequate ventilation, light sedation and enabling early hospital discharge.
authors.affiliation: Servicio de Anestesiología y Reanimación, Hospital Universitario La Paz, Madrid, España. Electronic address: antonioperezferrer@gmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Perez-Ferrer
authors.affiliation: Servicio de Anestesiología y Reanimación, Hospital Universitario La Paz, Madrid, España.
authors.forename: E
authors.initials: E
authors.lastname: Gredilla-Díaz
authors.affiliation: Servicio de Anestesiología y Reanimación, Hospital Universitario La Paz, Madrid, España.
authors.forename: J
authors.initials: J
authors.lastname: de Vicente-Sánchez
authors.affiliation: Servicio de Anestesiología y Reanimación, Hospital Universitario La Paz, Madrid, España.
authors.forename: A
authors.initials: A
authors.lastname: Kollmann-Camaiora
authors.affiliation: Servicio de Oncología Radioterápica, Hospital Universitario La Paz, Madrid, España.
authors.forename: A
authors.initials: A
authors.lastname: Escribano
mesh_terms: D002648:Child; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D008397:Masks; D016684:Prone Position; D011446:Prospective Studies; D012119:Respiration
keywords: Airway management; CPAP ventilation; Decúbito prono; Manejo de la vía aérea; Non-invasive ventilation; Prone position; Radioterapia; Radiotherapy; Ventilación CPAP; Ventilación no invasiva