title: A comparative study of hemodynamic changes between prone and supine emergence from anesthesia in lumbar disc surgery.
abstract: BACKGROUND
  Supine emergence from anesthesia in patients undergoing lumbar surgery in prone position leads to tachycardia, hypertension, coughing, laryngospasm and loss of monitoring as the patients are rolled back to supine position at the end of surgery. The prone extubation might facilitate a smoother emergence because the patients are not disturbed during emergence and secretions are drained away from patient's airway.
  
  
  METHODS
  The patients were randomly allocated to one of the two groups of 30 each at conclusion of surgery. First group was extubated in prone position and second in supine position at conclusion of surgery. Supine group patients were rolled back and prone group patients were left undisturbed. Extubation was done after complete reversal of neuromuscular block. Heart rates (HR), mean arterial pressure (MAP) were noted at various points of time. Coughing, laryngospasm, vomiting, monitor disconnection if any were also noted.
  
  
  RESULTS
  During emergence from anesthesia heart rate was significantly more in group S than group P at all intervals (P < 0.001). Mean arterial pressure was significantly higher in the supine group at 2, 3, and 4 min compared to prone group (P = 0.003). Compared to supine patients, prone patients had fewer incidences of coughing (P = 0. 0004), laryngospasm, vomiting and monitor disconnection.
  
  
  CONCLUSIONS
  In healthy normotensive patients, emergence from anesthesia in the prone position is associated with minimal hemodynamic change, and fewer incidences of coughing, laryngospasm, and monitor disconnections.
authors.affiliation: Department of Anaesthesiology, KVG Medical College and Hospital, Sullia, Karnataka, India.
authors.forename: Shivakumar M
authors.initials: SM
authors.lastname: Channabasappa
authors.affiliation: Department of Anaesthesiology, KVG Medical College and Hospital, Sullia, Karnataka, India.
authors.forename: P
authors.initials: P
authors.lastname: Shankarnarayana
keywords: Coughing; hemodynamic stimulation; lumbar surgery; prone emergence; supine emergence