Emergence from Anaesthesia in Supine versus Prone Position in Patients Undergoing Lumbar Laminectomy: A Study of 60 Cases

Background. Emergence in supine position in patients undergoing surgery in prone position leads to tachycardia and hypertension, coughing, and the loss of monitoring when patients are rolled to supine position at the end of surgery, aim of this prospective randomized trial was to study whether prone emergence causes less hemodynamic stimulation, coughing, and monitor disconnection compared to supine emergence in patients undergoing lumbar laminectomy. Patients and Methods. This study was conducted on 60 patients who underwent Lumbar laminectomy in prone position. Patients were anaesthetized using injected fentanyl 2？μg？kg？1, midazolam 0.1？mg？kg？1, and thiopentone 5–6？mg？kg？1 and vecuronium bromide. At the end of surgery patients were randomized into prone or supine group of 30 each. Supine group patients were rolled back and prone were left undisturbed. Extubation was done after complete reversal of neuromuscular block. Heart rates and MAP were noted at various points of time. Coughing, vomiting, monitor disconnection if any. Results. Mean arterial pressure and heart rate were significantly higher in supine patients as compared to prone patients before and after extubation (P value < 0.05). Incidence of coughing, vomiting and monitor disconnection was highly significant in prone group than in supine group. Conclusion. Emergence and extubation in prone position can be safely performed in selected group of patients undergoing surgery in prone position. 1. Introduction Emergence from anaesthesia in supine position in patients undergoing surgery in prone position leads to hemodynamic changes in the form of tachycardia and hypertension, coughing, and loss of monitoring when patients are rolled to supine position at the end of surgery [1]. Lifting and turning of head during position change from prone to supine causes tracheal irritation because of presence of endotracheal tube, thereby precipitating cough and bronchospasm, and leads to haemodynamic changes [2, 3]. These changes may lead to increased surgical bleeding, myocardial ischemia, and increased abdominal and intracranial pressure. Various drugs like injected esmolol, [4] intracuff [5] intravenous lidocaine [3], and alpha agonist dexmedetomidine have been tried to attenuate circulatory and airway reflexes during extubation in supine position. Emergence in prone position has been found to be associated with less hemodynamic alterations, less coughing and vomiting and monitor disconnections in patients undergoing lumbar surgery [6, 7]. We have taken up this study as there are very few [8] studies that