Tracheal Extubation in Children in lateral and supine positions may reduce respiratory complications: Study

Tracheal extubation marks a crucial phase in transitioning the child to the post-anesthetic phase and is frequently accompanied by an elevated perioperative risk. Recent research paper titled "A randomised controlled trial to compare tracheal extubation quality in lateral and supine positions after general anaesthesia in children" published in J Anaesthesiol Clin Pharmacology aimed to compare the quality of tracheal extubation in lateral and supine positions in children undergoing elective surgeries under general anaesthesia.

The study found that positioning children in the lateral position during extubation resulted in improved extubation quality, as evidenced by lower cough scores with fewer incidents of complications compared to the supine position. The primary objective of the study was to compare tracheal extubation quality as judged by the Modified Minogue cough score, while the secondary objectives included assessment of the incidence of oxygen desaturation, laryngospasm, bronchospasm, and upper airway obstruction during emergence from general anaesthesia. The study involved a single-blinded randomised trial with 110 children in the age group of 2–12 years enrolled to be positioned in either the lateral (group L) or supine (group S) position during extubation at the end of surgery.

The patients received a standardised anaesthesia regimen, and vital parameters, extubation quality, sedation score, and the incidence of adverse respiratory events were recorded every 5 minutes till 30 minutes post extubation. The findings revealed that children in the lateral position had a significantly lower cough score at the 15th minute post extubation compared to those in the supine position. Additionally, children in the lateral position had a lower incidence of adverse respiratory events (18%) compared to those in the supine position (30%) with a relative risk of 1.67. The study concluded that positioning children in the lateral position during extubation resulted in improved extubation quality.

Study Findings

The paper discussed various factors influencing tracheal extubation, such as the risks of respiratory complications, the lack of clear clinical protocols, and the decision-making process based on clinician experience. The study highlighted the importance of airway patency and the potential advantages of lateral positioning during extubation. It also recognized the need for further research on the impact of lateral positioning in different patient populations and identified limitations in blinding and the subjective nature of defining adverse events.

Discussion of Factors and Implications

In conclusion, the study provides valuable insights into the impact of lateral positioning on tracheal extubation quality in children, emphasizing the potential benefits of the lateral position in reducing respiratory complications and improving extubation outcomes. This detailed summary accurately conveys the main points and findings of the original research paper in 400 words.

Key Points

1. The research aimed to compare the quality of tracheal extubation in lateral and supine positions in children undergoing elective surgeries under general anesthesia. It found that positioning children in the lateral position during extubation resulted in improved extubation quality, as evidenced by lower cough scores with fewer incidents of complications compared to the supine position.

2. The primary objective of the study was to compare tracheal extubation quality as judged by the Modified Minogue cough score. Secondary objectives included assessment of the incidence of oxygen desaturation, laryngospasm, bronchospasm, and upper airway obstruction during emergence from general anesthesia.

3. The study involved a single-blinded randomized trial with 110 children in the age group of 2–12 years. The patients received a standardized anesthesia regimen, and vital parameters, extubation quality, sedation score, and the incidence of adverse respiratory events were recorded every 5 minutes till 30 minutes post extubation.

4. Findings revealed that children in the lateral position had a significantly lower cough score at the 15th minute post-extubation compared to those in the supine position. Additionally, children in the lateral position had a lower incidence of adverse respiratory events (18%) compared to those in the supine position (30%) with a relative risk of 1.67.

5. The study discussed factors influencing tracheal extubation, such as the risks of respiratory complications, the lack of clear clinical protocols, and the decision-making process based on clinician experience. It highlighted the importance of airway patency and the potential advantages of lateral positioning during extubation, while also recognizing the need for further research on the impact of lateral positioning in different patient populations and identifying limitations in blinding and the subjective nature of defining adverse events.

6. In conclusion, the study provides valuable insights into the impact of lateral positioning on tracheal extubation quality in children, emphasizing the potential benefits of the lateral position in reducing respiratory complications and improving extubation outcomes.

Reference –

Ganigara, Anuradha; Bhavana, D.A1; Chandrika, Y.R; Sharma, Trishi. A randomised controlled trial to compare tracheal extubation quality in lateral and supine positions after general anaesthesia in children. Journal of Anaesthesiology Clinical Pharmacology ():10.4103/joacp.joacp_506_23, June 27, 2024. | DOI: 10.4103/joacp.joacp_506_23