A Comparative Study of Extubation in Prone and Supine Position in Patients Undergoing Lumbar Spine Surgery in Prone Position

Abstract

Aim: In case of surgeries done in prone position, patients are rolled to supine during extubation which is associated with loss of monitoring and hemodynamic change. Also, incidence of coughing and bucking are noted. Several studies have shown that prone position extubation is associated with reduced frequency of coughing and monitor disconnection in prone position surgeries. The purpose of this study was to compare the safety and efficacy of patients extubated in prone and supine posted for lumbar spine surgery.
 Study Design: 60 patients varying from age 18 - 65 years and posted for lumbar spine surgery under general anaesthesia in prone position were randomly allocated to any one of the two groups Group P - In this group extubation was done in prone position at the end of surgery or Group S – In this group extubation was done in supine position at the end of surgery.
 Place and Duration of Study: Jawaharlal Nehru Medical College, DMIMS (DU), Acharya Vinoba Bhave Rural Hospital (AVBRH), Datta Meghe Institute of Medical Sciences, Sawangi (M), Wardha over the period of 1 year (2019 - 2020).
 Methods: A double blinded randomized controlled comparative study was conducted on 60 patients with primary objective to measure incidence of coughing and severity of coughing in prone vs supine extubation. Patients were anesthetized with fentanyl, nitrous oxide, sevoflurane, and vecuronium. Neuromuscular blockade was reversed in prone position and all patients had spontaneous ventilation at the conclusion of surgery. At time 0, patients were randomly divided into group P or group S. Patients in the group S were then rolled over, while those in the prone position remained undisturbed. Frequency of cough, monitor disconnection and changes in heart rate (HR) and mean arterial pressure (MAP) were noted during extubation. Patient were extubated on purposeful behaviour and eye opening.
 Results: Frequency of coughing was significantly less in prone patients in comparison to supine group (6 vs. 24 coughs) monitor disconnections dysconnectivity was also fewer (p < 0.001), little change in haemodynamics was noted during extubation. Time to extubation from time 0 was comparatively more in Group S. Airway rescue was not needed.
 Conclusions: Extubation in prone position is associated with lesser frequency of coughing, disruption of monitors and significantly less hemodynamic changes as compared to supine position extubation he abstract should be concise and informative. It should not exceed 300 words in length. It should briefly describe the purpose of the work, techniques and methods used, major findings with important data and conclusions. Different sub-sections, as given below, should be used. No references should be cited in this part. Generally non-standard abbreviations should not be used, if necessary they should be clearly defined in the abstract, at first use.