Prone Position Emergence From Anaesthesia in Lumbar Disc Surgery
Condition: Haemodynamic Changes During During Emergence; Airway Response During Emergence; Monitor Disconnection During Emergence
Study type: Interventional

Summary: 
      Compare haemodynamic changes and to evaluate the incidence of coughing, laryngospasm, loss of
      monitoring in patients undergoing lumbar disc surgery extubated in prone position and supine
      position.
    

Detailed description: 
      Tracheal irritation from the endotracheal tube, with subsequent coughing is common during
      emergence from general anaesthesia supine position and is often thought not to be a
      complication, but a physiological response to protect the airway from aspiration, although
      the side-effects of this vital reflex may be highly undesirable in clinical practice.

      Coughing not only causes significant patient discomfort, but it may also cause hypertension,
      tachycardia, and increased intracranial, intraocular, and intra-abdominal pressure, which may
      lead to myocardial ischemia, arrhythmias, or surgical complications. Supine extubation also
      leads increased incidences of breath holding, laryngospasm, coughing, and monitor
      disconnection. These haemodynamic and airway responses are largely related movement of
      endotracheal tube during rolling of patients back to supine position during lighter depth of
      anaesthesia at conclusion of surgery. Coughing, breath holding, and laryngospasm also related
      to pooling of secretions to dependent patients airway in supine position.

      Various techniques and drugs for the prevention of cardiovascular response and coughing
      during emergence have been studied, including extubation in a deep plane of anaesthesia,
      administration of intravenous drugs such as esmolol, lidocaine, short-acting opioids, or
      dexmedetomidine, and intracuff lidocaine. A reliable means of preventing undesired coughing
      has not been demonstrated to date.

      Emergence in prone position has been found to be associated with less hemodynamic
      alterations, less coughing, laryngospasm, vomiting and monitor disconnections in patients
      undergoing lumbar surgery. There is a paucity of data regarding safety and efficacy of
      emergence from anaesthesia in prone position. The investigators present our initial
      experience of emergence from anaesthesia in prone position as compared to supine position in
      normotensive patients undergoing lumbar surgery in prone position.
    

Intervention name(s): Prone and Supine emergence from anaesthesia
Intervention type(s): Procedure
Intervention description(s): Aims: The aim of this study was to compare haemodynamic changes and to evaluate the incidence of coughing, laryngospasm, loss of monitoring in patients undergoing lumbar disc surgery extubated in prone position and supine position. Settings and design: This open-level prospective randomized study was carried out in 50 patients who were admitted for elective lumbar surgery. Methods: The patients were randomly allocated to one of the two groups of 25 each at conclusion of surgery. First group was extubated in prone position and second in supine position at conclusion of surgery. Supine group patients were rolled back and prone group patients were left undisturbed. Extubation was done after complete reversal of neuromuscular block. Heart rates, Mean Arterial Pressure were noted at various points of time. Coughing, laryngospasm, vomiting, monitor disconnection if any were also noted. Statistical methods: Data was analyzed using
Intervention MeSH terms: Anesthetics
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Prone emergence; supine emergence; coughing; haemodynamic stimulation; lumbar surgery