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Comparison of lateral and supine positions for tracheal extubation in children

A randomized clinical trial

Vergleich der Seiten- und Rückenlage für die tracheale Extubation bei Kindern

Eine randomisierte klinische Studie

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Abstract

Background

The lateral position is known to be advantageous for maintaining airway patency. This study compared the lateral and supine positions for tracheal extubation in pediatric patients when performing deep extubation.

Objective

The hypothesis was that tracheal extubation in the lateral position would improve airway obstruction that often occurs immediately after extubation and can be a practical method.

Material and methods

This prospective randomized trial was performed in operating rooms in a tertiary care hospital and included 92 patients (3–12 years old) undergoing elective strabismus surgery. The patients were randomly divided into two groups: deep extubation in the supine position (group S) and deep extubation in the lateral position (group L). Oxygen saturation (SpO2) and the incidence of stridor, laryngospasm, and coughing after tracheal extubation were assessed.

Results

The mean ± standard deviation of the lowest SpO2 values within 5 min after extubation was significantly higher in group L (98.3 ± 2.1%) than in group S (96.8 ± 2.5%, mean difference 1.5, 95% confidence interval, CI 0.5–2.5, p = 0.003). The incidences of stridor and laryngospasm of group L were significantly lower than those of group S (1/45, 2% vs. 8/45, 18%, respectively; relative risk 1.9, 95% CI 1.4–2.7, p = 0.03). The incidence of desaturation and coughing were not significantly different between groups.

Conclusion

In pediatric patients deep extubation in the lateral position improved SpO2 and reduced the incidence of stridor and laryngospasm in the early emergence period when compared to extubation in the supine position.

Zusammenfassung

Hintergrund

Die seitliche Position ist als vorteilhaft für die Aufrechterhaltung der Durchgängigkeit der Atemwege bekannt. In dieser Studie wurden die laterale Position und die Rückenlage für die trachealen Extubation bei pädiatrischen Patienten bei tiefer Extubation verglichen.

Ziel der Arbeit

Die Hypothese lautete, dass eine Trachea-Extubation in Seitenlage eine praktische Methode darstellen kann, da sie die Atemwegsobstruktion verbessern würde, welche häufig unmittelbar nach der Extubation auftritt.

Material und Methoden

Diese prospektive randomisierte Studie wurde in Operationssälen in einer Tertiärklinik durchgeführt und umfasste 92 Patienten (3–12 Jahre), die sich einer elektiven Strabismusoperation unterzogen hatten. Die Patienten wurden zufällig in 2 Gruppen eingeteilt: tiefe Extubation in Rückenlage (Gruppe S) und tiefe Extubation in Seitenlage (Gruppe L). Die Sauerstoffsättigung (SpO2) und die Häufigkeit von Stridor, Laryngospasmus und Husten nach trachealer Extubation wurden bewertet.

Ergebnisse

Der Mittelwert ± Standardabweichung der niedrigsten SpO2-Werte innerhalb von 5 min nach Extubation war in Gruppe L (98,3 ± 2,1 %) signifikant höher als in Gruppe S (96,8 ± 2,5 %) (mittlere Differenz 1,5; 95 % Konfidenzintervall [KI] 0,5–2,5; p = 0,003). Die Inzidenz von Stridor und Laryngospasmus der Gruppe L war signifikant niedriger als die der Gruppe S (1/45 [2 %] vs. 8/45 [18 %]; relatives Risiko: 1,9; 95 % KI 1,4–2,7; p = 0,03). Die Häufigkeit von Entsättigung und Husten unterschied sich nicht signifikant zwischen den Gruppen.

Schlussfolgerung

Bei pädiatrischen Patienten verbesserte die tiefe Extubation in Seitenlage den SpO2-Wert und verringerte die Inzidenz von Stridor und Laryngospasmus in der frühen Erholungsphase im Vergleich zur Extubation in der Rückenlage.

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Authors and Affiliations

  1. Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, 807 Hoguk-ro, 41404, Buk-gu, Daegu, Korea (Republic of)

    H. Jung & H. J. Kim

  2. Department of Anesthesiology and Pain Medicine, Keimyung University Dongsan Medical center, Daegu, Korea (Republic of)

    H. J. Kim & Y.-C. Lee

Authors
  1. H. Jung
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  2. H. J. Kim
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  3. Y.-C. Lee
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  4. H. J. Kim
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Corresponding author

Correspondence to H. J. Kim.

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Conflict of interest

H. Jung, H.J. Kim, Y.-C. Lee and H.J. Kim declare that they have no competing interests.

Trial registration: http://www.who.int/ictrp/network/cris2/en/, CRIS, KCT0002570. Registered 1 December 2017.

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Jung, H., Kim, H.J., Lee, YC. et al. Comparison of lateral and supine positions for tracheal extubation in children. Anaesthesist 68, 303–308 (2019). https://doi.org/10.1007/s00101-019-0590-2

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  • DOI: https://doi.org/10.1007/s00101-019-0590-2

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