Jung H, Kim H J, Lee Y-C, Kim H J
Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, 807 Hoguk-ro, 41404, Buk-gu, Daegu, Korea (Republic of).
Department of Anesthesiology and Pain Medicine, Keimyung University Dongsan Medical center, Daegu, Korea (Republic of).
Anaesthesist. 2019 May;68(5):303-308. doi: 10.1007/s00101-019-0590-2. Epub 2019 Apr 16.
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.
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.
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 (SpO) and the incidence of stridor, laryngospasm, and coughing after tracheal extubation were assessed.
The mean ± standard deviation of the lowest SpO 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.
In pediatric patients deep extubation in the lateral position improved SpO and reduced the incidence of stridor and laryngospasm in the early emergence period when compared to extubation in the supine position.
已知侧卧位有利于维持气道通畅。本研究比较了小儿患者在深度拔管时侧卧位和仰卧位气管拔管的情况。
假设侧卧位气管拔管可改善拔管后常立即出现的气道梗阻，且是一种实用的方法。
这项前瞻性随机试验在一家三级护理医院的手术室进行，纳入了92例接受择期斜视手术的患者（3至12岁）。患者被随机分为两组：仰卧位深度拔管组（S组）和侧卧位深度拔管组（L组）。评估气管拔管后的血氧饱和度（SpO）以及喘鸣、喉痉挛和咳嗽的发生率。
拔管后5分钟内最低SpO值的平均值±标准差，L组（98.3±2.1%）显著高于S组（96.8±2.5%，平均差异1.5，95%置信区间，CI 0.5 - 2.5，p = 0.003）。L组的喘鸣和喉痉挛发生率显著低于S组（分别为1/45，2% 对8/45，18%；相对风险1.9，95% CI 1.4 - 2.7，p = 0.03）。两组之间的血氧饱和度降低和咳嗽发生率无显著差异。
与仰卧位拔管相比，小儿患者侧卧位深度拔管在苏醒早期改善了SpO，并降低了喘鸣和喉痉挛的发生率。
