Clinical trial NCT01441700: Prone Position Emergence From Anaesthesia in Lumbar Disc Surgery
Official title: A Comparative Study of Haemodynamic Changes Between Prone and Supine Emergence From Anaesthesia in Lumbar Disc Surgery
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Haemodynamic Changes During During Emergence
Airway Response During Emergence
Monitor Disconnection During Emergence
Keywords: Prone emergence
supine emergence
coughing
haemodynamic stimulation
lumbar surgery
Lead sponsor: KVG Medical College and Hospital
Sponsor class: OTHER
First posted: 2011-09-28
Enrollment: 50
Sex: ALL
Minimum age (years): 18
Maximum age (years): 60
Standard ages: ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief 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.

Eligibility criteria: Inclusion Criteria:

* age between 18-60 years
* prone surgery
* lumbar disc surgery

Exclusion Criteria:

* suspected difficult airway,
* risk factors for perioperative aspiration,
* chronic coughing,
* recent history of respiratory tract infection,
* chronic obstructive lung disease and
* obesity

Primary outcomes:
measure: Heart rate changes from conclusion of surgery to extubation
timeFrame: From conlusion surgery to extubation of patient
measure: Mean arterial pressure changes during emergence from anaesthesia
timeFrame: From conclusion of surgery to extubation
Secondary outcomes:
Other outcomes:
Locations:
Study officials:
affiliation: KVG Medical College and Hospital
name: SHIVAKUMAR MC, MD
role: PRINCIPAL_INVESTIGATOR
References: