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- Title
Semirecumbent Positioning During Anesthesia Recovery and Postoperative Hypoxemia: A Randomized Clinical Trial.
- Authors
Wang, Xinghe; Guo, Kedi; Sun, Jia; Yang, Yuping; Wu, Yan; Tang, Xihui; Xu, Yuqing; Chen, Qingsong; Zeng, Si; Wang, Liwei; Liu, Su
- Abstract
Key Points: Question: Does semirecumbent positioning during recovery from anesthesia reduce the incidence of postoperative hypoxemia? Findings: In this randomized clinical trial that included 700 adults undergoing laparoscopic upper abdominal surgery, a 30° semirecumbent position during recovery from anesthesia reduced the incidence of postoperative hypoxemia from 47% in a supine position to 32%. Meaning: These findings suggest that a 30° semirecumbent position during recovery from anesthesia may help prevent the development of postoperative hypoxemia. This randomized clinical trial tests the efficacy and the optimal tilt angle of the semirecumbent position during anesthesia emergence in reducing postoperative hypoxemia among patients undergoing laparoscopic upper abdominal surgery. Importance: The efficacy of a semirecumbent position (SRP) in reducing postoperative hypoxemia during anesthesia emergence is unclear despite its widespread use. Objective: To determine the differences in postoperative hypoxemia between patients in an SRP and a supine position. Design, Setting, and Participants: This 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. Interventions: Patients 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 Measures: The primary outcome was the incidence of postoperative hypoxemia in the postanesthesia care unit. Severe hypoxemia was also evaluated. Results: Out 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 Relevance: In 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 Registration: Chinese Clinical Trial Registry Identifier: ChiCTR2100045087
- Subjects
CHINA; PREVENTION of surgical complications; ABDOMEN; REPEATED measures design; DATA analysis; RESEARCH funding; LAPAROSCOPIC surgery; STATISTICAL sampling; KRUSKAL-Wallis Test; FISHER exact test; LOGISTIC regression analysis; TREATMENT effectiveness; RANDOMIZED controlled trials; TERTIARY care; SEVERITY of illness index; DESCRIPTIVE statistics; CHI-squared test; SUPINE position; RECOVERY rooms; SURGICAL complications; ODDS ratio; KAPLAN-Meier estimator; ONE-way analysis of variance; STATISTICS; GENERAL anesthesia; CONFIDENCE intervals; DATA analysis software; PATIENT positioning; ANESTHESIA; HYPOXEMIA; DISEASE incidence
- Publication
JAMA Network Open, 2024, Vol 7, Issue 6, pe2416797
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2024.16797