Airway Management in Post Anaesthetic Care

Scott, Bevan Michael

doi:10.1177/175045891202200407

Cited by 11 publications

(6 citation statements)

References 11 publications

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“…Besides hypoxaemia, postoperative hypoventilation and respiratory depression are usually attributed to anaesthetic drugs affecting central respiratory drive (Nicholau ), while upper airway obstruction can be due to a variety of causes, such as tongue falling back against the posterior pharynx, laryngospasm, bronchospasm, laryngeal oedema or bleeding, secretions and depressed level of consciousness (Hillman et al . , Scott ).…”

Section: Introductionmentioning

confidence: 99%

Residual neuromuscular blockade and postoperative critical respiratory events: literature review

Kiekkas

Bakalis

Stefanopoulos

et al. 2014

Journal of Clinical Nursing

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Section: Introductionmentioning

confidence: 99%

Residual neuromuscular blockade and postoperative critical respiratory events: literature review

Kiekkas

Bakalis

Stefanopoulos

et al. 2014

Journal of Clinical Nursing

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“…Patient positioning during anesthesia emergence is related to perioperative and postoperative complications . While there is no established consensus on the optimal patient position for extubation, the supine position is often favored by anesthesiologists due to its simplicity and ease of observation . However, the reduction in functional residual capacity associated with the supine position tends to promote airway closure and reduced gas exchange .…”

Section: Introductionmentioning

confidence: 99%

Semirecumbent Positioning During Anesthesia Recovery and Postoperative Hypoxemia

Wang,

Guo,

Sun

et al. 2024

JAMA Netw Open

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ImportanceThe efficacy of a semirecumbent position (SRP) in reducing postoperative hypoxemia during anesthesia emergence is unclear despite its widespread use.ObjectiveTo determine the differences in postoperative hypoxemia between patients in an SRP and a supine position.Design, Setting, and ParticipantsThis randomized clinical trial was performed at a tertiary hospital in China between March 20, 2021, and May 10, 2022. Patients scheduled to undergo laparoscopic upper abdominal surgery under general anesthesia were enrolled. Study recruitment and follow-up are complete.InterventionsPatients were randomized to 1 of the following positions at the end of the operation until leaving the postanesthesia care unit: supine (group S), 15° SRP (group F), or 30° SRP (group T).Main Outcomes and MeasuresThe primary outcome was the incidence of postoperative hypoxemia in the postanesthesia care unit. Severe hypoxemia was also evaluated.ResultsOut of 700 patients (364 men [52.0%]; mean [SD] age, 47.8 [11.3] years), 233 were randomized to group S (126 men [54.1%]; mean [SD] age, 48.2 [10.9] years), 233 to group F (122 men [52.4%]; mean [SD] age, 48.1 [10.9] years), and 234 to group T (118 women [50.4%]; mean [SD] age, 47.2 [12.1] years). Postoperative hypoxemia differed significantly among the 3 groups (group S, 109 of 233 [46.8%]; group F, 105 of 233 [45.1%]; group T, 76 of 234 [32.5%]; P = .002). This difference was statistically significant for groups T vs S (risk ratio [RR], 0.69 [95% CI, 0.55-0.87]; P = .002) and groups T vs F (RR, 0.72 [95% CI, 0.57-0.91]; P = .007), but not for groups F vs S (RR, 0.96 [95% CI, 0.79-1.17]; P = .78). Severe hypoxemia also differed among the 3 groups (group S, 61 of 233 [26.2%]; group F, 53 of 233 [22.7%]; group T, 36 of 234 [15.4%]; P = .01). This difference was statistically significant for groups T vs S (RR, 0.59 [95% CI, 0.41-0.85]; P = .005).Conclusions and RelevanceIn this randomized clinical trial of SRP during anesthesia recovery in patients undergoing laparoscopic upper abdominal surgery, postoperative hypoxemia was significantly reduced in group T compared with group F or group S.Trial RegistrationChinese Clinical Trial Registry Identifier: ChiCTR2100045087

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“…After administering general anesthesia, most anesthetists prefer to place patients in the supine position for extubation. This is because it is simple, enables easy observation, and can prevent regurgitation in the case of vomiting [ 5 ]. However, some believe that awake extubation recovers protective reflexes, such as coughing and swallowing, after extubation; in this case, the advantages of supine extubation are diminished [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Supine versus semi-Fowler’s positions for tracheal extubation in abdominal surgery-a randomized clinical trial

Zhu

Huang

et al. 2020

BMC Anesthesiol

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Background Tracheal 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. Methods We 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. Results In 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. Conclusion Tracheal 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 registration Chinese Clinical Trial Registry, ChiCTR1900025566 . Registered on 1st September 2019.

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Airway Management in Post Anaesthetic Care

Cited by 11 publications

References 11 publications

Residual neuromuscular blockade and postoperative critical respiratory events: literature review

Residual neuromuscular blockade and postoperative critical respiratory events: literature review

Semirecumbent Positioning During Anesthesia Recovery and Postoperative Hypoxemia

Supine versus semi-Fowler’s positions for tracheal extubation in abdominal surgery-a randomized clinical trial

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