Effect of The Gel Positioning Pads Placement on Airway Pressure During Prone Percutaneous Nephrolithotomy: A Prospective Randomized Controlled Trial
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Abstract
Objective: To study the mean airway pressure levels when positioning the gel pad support transversely versus vertically during percutaneous nephrolithotomy (PCNL) surgery performed in the prone position.
Methods: A randomized controlled trial (RCT) was conducted on patients aged 18 years and older who were diagnosed with kidney stones requiring treatment via percutaneous nephrolithotomy in the prone position, with no contraindications for surgery. A total of 76 participants were randomly divided into two groups, 38 participants each, using block-of-four randomization via computer software. The experimental group received vertical gel pad placement, while the control group received transverse gel pad placement. Data were collected using a pressure recording sheet for airway pressure, peak inspiratory pressure (PIP), and plateau pressure (Pplat) after anesthesia induction and following the prone position change at 1, 5, 30, and 60 minutes, and at the conclusion of the surgery in the supine position. The differences between the experimental and control groups were analyzed using Chi-squared (χ²) tests or Fisher’s exact tests for categorical variables. The mean changes in airway pressure, peak inspiratory pressure, and end-inspiratory pressure at the specified time points were compared using Student’s t-tests. A p-value of <0.05 was considered statistically significant. The study was conducted from May 2021 to June 2024.
Results: The study found no statistically significant differences (p < 0.05) in the mean airway pressure, peak inspiratory pressure, and plateau pressure at 1, 5, 30, and 60 minutes after anesthesia induction and transitioning to the prone position, as well as at the conclusion of surgery in the supine position, between the transverse and vertical gel pad placement groups during percutaneous nephrolithotomy. Additionally, there were no significant differences in complications or blood loss volume between the experimental and control groups.
Conclusion: The transverse and vertical positioning of gel pad supports during surgery in the supine and prone positions did not affect airway pressure. This suggests that both transverse and vertical gel pad positioning can be safely and effectively applied during surgery, ensuring optimal and safe treatment for patients.
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