Document Detail


Emergence from anesthesia in the prone versus supine position in patients undergoing lumbar surgery.
MedLine Citation:
PMID:  11020746     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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:
M A Olympio; B L Youngblood; R L James
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Anesthesiology     Volume:  93     ISSN:  0003-3022     ISO Abbreviation:  Anesthesiology     Publication Date:  2000 Oct 
Date Detail:
Created Date:  2000-10-13     Completed Date:  2000-10-27     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  1300217     Medline TA:  Anesthesiology     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  959-63     Citation Subset:  AIM; IM    
Affiliation:
Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA. molympio@wfubmc.edu
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MeSH Terms
Descriptor/Qualifier:
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:
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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