Abstract
BackgroundTracheal extubation is commonly performed in the supine position. However, in patients undergoing abdominal surgery, the supine position increases abdominal wall tension, especially during coughing and deep breathing, which may aggravate pain and lead to abdominal wound dehiscence. The semi-Fowler’s position may reduce abdominal wall tension, but its safety and comfort in tracheal extubation have not been reported. We aimed to evaluate the safety and comfort of different extubation positions in patients undergoing abdominal surgery.MethodsWe enrolled 141 patients with an American Society of Anesthesiologists grade of I-III who underwent abdominal surgery. All patients were anesthetized with propofol, fentanyl, cisatracurium, and sevoflurane. After surgery, all patients were transferred to the post-anesthesia care unit (PACU). Patients were then randomly put into the semi-Fowler’s (n = 70) or supine (n = 71) position while 100% oxygen was administered. The endotracheal tube was removed after the patients opened their eyes and regained consciousness. Vital signs, coughing, and pain and comfort scores before and/or after extubation were recorded until the patients left the PACU.ResultsIn comparison with the supine position, the semi-Fowler’s position significantly decreased the wound pain scores at all intervals after extubation (3.51 ± 2.50 vs. 4.58 ± 2.26, 2.23 ± 1.68 vs. 3.11 ± 2.00, 1.81 ± 1.32 vs. 2.59 ± 1.88, P = 0.009, 0.005 and 0.005, respectively), reduced severe coughing (8[11.43%] vs. 21[29.58%], P = 0.008) and bucking after extubation (3[4.29%] vs. 18[25.35%], P < 0.001), and improved the comfort scores 5 min after extubation (6.11 ± 2.30 vs. 5.17 ± 1.78, P = 0.007) and when leaving from post-anesthesia care unit (7.17 ± 2.27 vs. 6.44 ± 1.79, P = 0.034). The incidences of vomiting, emergence agitation, and respiratory complications were of no significant difference.ConclusionTracheal extubation in the semi-Fowler’s position is associated with less coughing, sputum suction, and pain, and more comfort, without specific adverse effects when compared to the conventional supine position.Trial registrationChinese Clinical Trial Registry, ChiCTR1900025566. Registered on 1st September 2019.
Highlights
Tracheal extubation is commonly performed in the supine position
Studies have shown that the extubation position during emergence from anesthesia is related to the peri- and postoperative complications
Because there is currently no evidence that a single extubation position is suitable for all patients, we assumed that patients should be placed in different positions based on their conditions
Summary
In patients undergoing abdominal surgery, the supine position increases abdominal wall tension, especially during coughing and deep breathing, which may aggravate pain and lead to abdominal wound dehiscence. We aimed to evaluate the safety and comfort of different extubation positions in patients undergoing abdominal surgery. A retrospective study of 18,473 patients found that the overall incidence of PACU complications was 23% and the most common complications included postoperative nausea and vomiting (10 to 30%), upper airway abnormalities (6.9%), hypotension (2.7%), arrhythmia (1.4%), hypertension (1.1%), and altered consciousness (0.6%) [1]. For patients with obstructive sleep apnea after uvulopalatopharyngoplasty, extubation in the upright position can significantly reduce the upper airway blocking, the work of breathing, postoperative respiratory depression, and increase functional residual capacity [2] Another study found that extubation in the prone position can significantly reduce postoperative coughing in patients undergoing spinal surgery [3]. Because there is currently no evidence that a single extubation position is suitable for all patients, we assumed that patients should be placed in different positions based on their conditions
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