title: Emergence from anesthesia in the prone versus supine position in patients undergoing lumbar surgery.
abstract: 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.affiliation: Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA. molympio@wfubmc.edu
authors.forename: M A
authors.initials: MA
authors.lastname: Olympio
authors.forename: B L
authors.initials: BL
authors.lastname: Youngblood
authors.forename: R L
authors.initials: RL
authors.lastname: James
mesh_terms: D000732:Androstanols; D000762:Anesthesia Recovery Period; D000769:Anesthesia, Inhalation / Q000009:adverse effects / Q000379:methods*; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D001794:Blood Pressure / Q000502:physiology; D003243:Consciousness / Q000502:physiology; D003371:Cough / Q000209:etiology / Q000517:prevention & control; D005260:Female; D005283:Fentanyl; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000379:methods; D007530:Isoflurane; D007796:Laminectomy / Q000379:methods*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D003473:Neuromuscular Nondepolarizing Agents; D009609:Nitrous Oxide; D016684:Prone Position / Q000502:physiology*; D000077123:Rocuronium; D016683:Supine Position / Q000502:physiology*
chemical_list: D000732:Androstanols; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D003473:Neuromuscular Nondepolarizing Agents; D007530:Isoflurane; D009609:Nitrous Oxide; D005283:Fentanyl; D000077123:Rocuronium