| Emergence from anesthesia in the prone versus supine position in patients undergoing lumbar surgery. | |
MedLine Citation:
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PMID: 11020746 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Conventional supine emergence in patients undergoing prone lumbar surgery frequently results in tachycardia, hypertension, coughing, and loss of monitoring as the patient is rolled supine. The prone position might facilitate a smoother emergence because the patient is not disturbed. No data describe this technique. METHODS: Fifty patients were anesthetized with fentanyl, nitrous oxide, isoflurane, and rocuronium. By the conclusion of surgery, all patients achieved spontaneous ventilation and full reversal of neuromuscular blockade in the prone position, as the volatile anesthetic level was reduced. Baseline heart rate and mean arterial pressure were recorded. Patients were then randomized at time 0 to the supine (n = 24) or prone (n = 21) position as 100% oxygen was administered. Patients in the supine position were then rolled over, while those in the prone position remained undisturbed. Heart rate, mean arterial pressure, and coughs were recorded until extubation. Tracheas were extubated on eye opening or purposeful behavior. RESULTS: When compared with the supine group, prone patients had significantly less increase in heart rate (P = 0.0003, maximum increase 9.3 vs. 25 beats/min), less increase in mean arterial pressure (P = 0.0063, maximum increase 4.8 vs. 19 mmHg), less coughing (P = 0.0004, 7.0 vs. 23 coughs), and fewer monitor disconnections (P < 0.0001). Time to extubation from time 0 was similar (4.0 vs. 3.7 min, prone vs. supine). No one required airway rescue. There was no significant difference in need for restraint (three prone, four supine). CONCLUSIONS: Prone emergence and extubation is associated with less hemodynamic stimulation, less coughing, and less disruption of monitors, without specifically observed adverse effects, when compared with conventional supine techniques. |
Authors:
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M A Olympio; B L Youngblood; R L James |
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Publication Detail:
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Type: Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Anesthesiology Volume: 93 ISSN: 0003-3022 ISO Abbreviation: Anesthesiology Publication Date: 2000 Oct |
Date Detail:
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Created Date: 2000-10-13 Completed Date: 2000-10-27 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 1300217 Medline TA: Anesthesiology Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 959-63 Citation Subset: AIM; IM |
Affiliation:
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Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA. molympio@wfubmc.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Androstanols Anesthesia Recovery Period Anesthesia, Inhalation / adverse effects, methods* Anesthetics, Inhalation Anesthetics, Intravenous Blood Pressure / physiology Consciousness / physiology Cough / etiology, prevention & control Female Fentanyl Heart Rate / physiology Humans Intubation, Intratracheal / adverse effects, methods Isoflurane Laminectomy / methods* Lumbar Vertebrae / surgery* Male Middle Aged Neuromuscular Nondepolarizing Agents Nitrous Oxide Prone Position / physiology* Supine Position / physiology* |
| Chemical | |
Reg. No./Substance:
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0/Androstanols; 0/Anesthetics, Inhalation; 0/Anesthetics, Intravenous; 0/Neuromuscular Nondepolarizing Agents; 10024-97-2/Nitrous Oxide; 143558-00-3/rocuronium; 26675-46-7/Isoflurane; 437-38-7/Fentanyl |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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