Comparison of different extubation techniques in lumbar surgery: prone extubation versus supine extubation with or without prior injection of intravenous lidocaine

The aim of this study was to evaluate the incidence of coughing and breath holding in patients undergoing lumbar surgery extubated in prone position, supine position, or supine position with intravenous lidocaine before extubation. About 105 ASA I to II patients undergoing lumbar surgery were extubated in prone position in group P (n = 35), in supine position in group S (n = 35) and in supine position with intravenous 1.5 mg/kg lidocaine 10 minutes before extubation in group SL (n = 35). The number of patients who coughed and demonstrated breath holding was noted at emergence period. The time of loss of monitoring while repositioning the patient was recorded. The frequency of cough in group S was higher compared with group P at 1 minute after extubation (P = 0.008). Two and three minutes after extubation, the patients in group S demonstrated higher cough incidence compared with groups P and SL (P < 0.05). The incidence of breath holding in the first 6 minutes was lower in group P (n = 11) compared with groups S (n = 29) and SL (n = 25)(P = 0.001). The loss of monitoring time was longer in groups S (62 +/- 40 s) and SL (53 +/- 39 s) when compared with group P (0 s) (P < 0.01). Prone emergence and supine emergence with intravenous lidocaine provides an alternative approach to conventional supine emergence and prone extubation offers less cough and breath holding and continuation of monitoring.