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

Abstract

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.

Effect of different head-high lateral extubation on adverse reactions in the peri-extubation period of pediatric OSAS surgery under general anesthesia

“…Therefore, he concluded that the lateral position is preferable to the supine position for mask removal. However, it has been observed that lateral position extubation at the conventional level (i.e., head-high 0°) may increase the risk of gastric contents regurgitation [ 11 ], whereas head-high extubation prevents regurgitation of gastric contents. It has also been shown that patients with general anesthesia are more comfortable in an appropriate head-high position (15° to 30°) after awakening.…”

Comparison of Postextubation Complications Between Positive-Pressure and Suctioning Techniques: A Systematic Review

“…6 Various extubation techniques, including a positive-pressure technique, suctioning technique, extubation in the semi-Fowler position, and extubation with sedative drugs, have been reported. [7][8][9] The positive-pressure technique comprises application of positive pressure through the airway during cuff deflation and extubation, whereas the suctioning technique comprises the introduction of a suction catheter into an endotracheal tube and application of conti-nuous suctioning during cuff deflation and extubation. Questionnaire surveys of ICU staff members in the United Kingdom and Argentina revealed that the suctioning technique was most frequently performed.…”

Effects of body positions on arterial stiffness as assessed by pulse wave velocity

“…To reduce pain and promote more relaxation and comfort, the patients rest with upper body tilted up with knees in mild flexion (i.e. Fowler or semi-Fowler's position) [11]. For similar reasons, PWV in pregnant women has been measured with upper body tilted up 308 or left side laying to avoid compression on abdominal vessels and lungs [12,13].…”