Original Investigation 

Anesthesiology

June 28, 2024

Semirecumbent Positioning During Anesthesia Recovery and Postoperative Hypoxemia: A Randomized Clinical Trial

Xinghe Wang, Kedi Guo, Jia Sun, et al

JAMA Netw Open. 2024;7(6):e2416797. doi:10.1001/jamanetworkopen.2024.16797

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.

Abstract

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