Comparison of lateral and supine positions for tracheal extubation in children : A randomized clinical trial

The lateral position is known to be advantageous for maintaining airway patency. This study compared the lateral and supine positions for tracheal extubation in pediatric patients when performing deep extubation.

The hypothesis was that tracheal extubation in the lateral position would improve airway obstruction that often occurs immediately after extubation and can be a practical method.

This prospective randomized trial was performed in operating rooms in a tertiary care hospital and included 92 patients (3-12 years old) undergoing elective strabismus surgery. The patients were randomly divided into two groups: deep extubation in the supine position (group S) and deep extubation in the lateral position (group L). Oxygen saturation (SpO₂) and the incidence of stridor, laryngospasm, and coughing after tracheal extubation were assessed.

The mean ± standard deviation of the lowest SpO₂ values within 5 min after extubation was significantly higher in group L (98.3 ± 2.1%) than in group S (96.8 ± 2.5%, mean difference 1.5, 95% confidence interval, CI 0.5-2.5, p = 0.003). The incidences of stridor and laryngospasm of group L were significantly lower than those of group S (1/45, 2% vs. 8/45, 18%, respectively; relative risk 1.9, 95% CI 1.4-2.7, p = 0.03). The incidence of desaturation and coughing were not significantly different between groups.

In pediatric patients deep extubation in the lateral position improved SpO₂ and reduced the incidence of stridor and laryngospasm in the early emergence period when compared to extubation in the supine position.