Emergence from anesthesia in the prone versus supine position in patients undergoing lumbar surgery

Background: Conventional supine emergence in patients undergoing prone lumb ar surgery frequently results in tachycardia, hypertension, coughing, and l oss of monitoring as the patient is rolled supine. The prone position might facilitate a smoother emergence because the patient is not disturbed. No d ata describe this technique. Methods: Fifty patients were anesthetized with fentanyl, nitrous oxide, iso flurane, and rocuronium. By the conclusion of surgery, all patients achieve d spontaneous ventilation and full reversal of neuromuscular blockade in th e prone position, as the volatile anesthetic level was reduced. Baseline he art rate and mean arterial pressure were recorded. Patients were then rando mized at time 0 to the supine (n = 24) or prone (n = 21) position as 100% o xygen was administered. Patients in the supine position were then rolled ov er, while those in the prone position remained undisturbed. Heart rate, mea n arterial pressure, and coughs were recorded until extubation. Tracheas we re extubated on eye opening or purposeful behavior. Results: When compared with the supine group, prone patients had significan tly less increase in heart rate (P = 0.0003, maximum increase 9.3 vs. 25 be ats/min), less increase in mean arterial pressure (P = 0.0063, maximum incr ease 4.8 us 19 mmHg), less coughing (P = 0.0004, 7.0 us. 23 coughs), and fe wer monitor disconnections (P < 0.0001). Time to extubation from time 0 was similar (4.0 vs. 3.7 min, prone us. supine). No one required airway rescue . There was no significant difference in need for restraint (three prone, f our supine). Conclusions: Prone emergence and extubation is associated with less hemodyn amic stimulation, less coughing, and less disruption of monitors, without s pecifically observed adverse effects, when compared with conventional supin e techniques.