HOT TOPIC
JUNE 2014
• How do you position your patients at the end of anaesthesia: lateral or
supine?
• What is the reasoning for your practice?
• Do you change your practice for tonsillectomy patients?
COMMENTS
"I position them on their backs. Manual airway manoeuvres are more reliable/easy to establish
effectively when supine. Contaminated airways need to be allowed to drain so left lateral head down is
best if patient has been extubated deep"
> "Generally I sit them up. Reasoning is: habit, was always my adult practice. Plus, I find it easier to
maintain the airway and there are the obvious respiratory advantages. If risk of dirtying the airway from
above (e.g. tonsillectomy) then left- lateral"
"I position them supine; having said that, I take most of my patients to Recovery with ETT in place and
then let them wake up with the No Touch Technique (A & A. 98(2):327-329, February 2004 ). LMA's get
taken out in the OR and onto recovery with OP airway, usually supine.
My reasoning? Besides the earlier point, I am able to better assess a child's breathing, while they are
supine. If I do a deep extubation (which is rare) and then find that the airway obstructs in the supine
position, I try turning the child on his side. I also practice the No Touch Technique very religiously on the
T&A patients: works great and this way they are pretty much awake at the time of extubation, with a 0
incidence of Laryngeal spasm (Really!) and minimal risk of obstruction in an OSA patient post
tonsillectomy."
"Supine generally. But sometimes supine if requiring CPAP. Reasoning: Less likely to obstruct/soil. I
generally leave the LMA in for tonsils but keep lateral."
"All patients in lateral position. No different for tonsils. Reason: I can easily extend head to clear the
airway and secretions/vomit less likely to be aspirated"
"As an older paediatric anaesthetist when I trained in the 80's (before LMAs) we were always taught to
turn all our patients (where practical) before taking them to Recovery, in case they vomited and
aspirated. In 2003 I had a sabattical and worked in a US Children's Hospital - their practice was to take
the child to Recovery on its back (usually turning the face only). Surprisingly their patients did fine. I
therefore changed my practice and don't turn children (more convenient with LMAs), unless they are at
high risk of vomiting.
Clearly it makes no difference which of these you do for the vast majority of paediatric anaesthetics."
"Supine, except for tonsillectomies and adenidectomies. For T+A, lateral."
"Lateral, for easy extubations, drainage and aspiration of secretions and blood. Usually lateral for
tonsillectomies."
"I put all my patients in the lateral position, as I think they are less likely to obstruct and hopefully less
chance of aspiration. The only exception are some of the large paediatric patients wh I tend to put
supine but head up."
"Lateral unless in hip spica/brace etc. This is better for patients to regurgitate/vomit/bleed onto pillow
rather then cords!It also takes into account patients who are anxious and dont have an empty
stomach,kids who've sneaked food/ drink,parents who've either not understood/lied about starvation.
Also, its easier to do this in theatre where you have a whole team versus 2 nurses in recovery. I do the
same for tonsils"
I always leave them supine. It is easier to hold the airway, provide bilateral jawthrust and re-intubate if
need be.
I do this even for adenotonsillectomies and I have never (yet!) regretted it in more than 20 years of
anaesthetic practice.