The effect of extubation in prone position on emergence and recovery in lumbar spinal surgery

Extubation of patients in supine position after prone operations may lead to unwanted effects on hemodynamic and respiratory parameters during emergence and recovery period. We aimed to observe the effects of prone position on emergence and recovery periods after prone surgery.

This randomized controlled trial was studied with sixty patients extubated either in prone position (30 patients) or in supine position (30 patients) after lumbar spinal surgery in tertiary educational hospitals. Heart rate, non-invasive arterial blood pressure, peripheral oxygen saturation and Bispectral Index values were measured, and recorded in all patients during operation, at the time an anesthetic agent was discontinued, before and after extubation. The number of the mouth suctioning, Aldrete recovery score, and Ricker agitation score were recorded together with the severity of cough during emergence and recovery. Incidents such as nausea, vomiting, respiratory failure, uncontrolled airway, and decreased saturation were also recorded.

Heart rate and mean arterial pressure values were significantly lower in the prone group during emergence and recovery period compared with the supine group (P<0.05). Aldrete Recovery Scores were higher in the prone group (P<0.001). The number of the mouth suctioning and the cough severity were lower in the prone group (P<0.001).

Extubation in the prone position provides a more comfortable emergence and recovery periods by less altering the hemodynamic and respiratory status with better recovery profile.