Positioning for Success: A Comparative Analysis of Supine and Semi-Fowler's Extubation in Laproscopic Abdominal Surgery

Abstract Introduction: Tracheal extubation following laproscopic abdominal surgery represents a critical phase, uniquely complicated by respiratory challenges arising from pneumoperitoneum-induced physiological alterations. While optimal patient positioning holds transformative potential for recovery, direct comparative evidence for supine versus semi-Fowler's positions is conspicuously sparse. This investigation meticulously examines these pivotal positions in the immediate post-extubation phase, precisely evaluating their impact on patient comfort, expiratory tidal volume, peak airway pressures and incidence of post-operative respiratory complications forging a path towards refined clinical protocols. Methods: The study included ASA grade I to III patients aged between 18 and 65 years of either sex, with a BMI of 18-30 kg/m2. Patients were computer-randomized into two groups undergoing laproscopic abdominal surgeries. Extubation was performed in supine and semifowler’s positions as per position allocation of the patients. All the patients after meeting extubation criterias were evaluated for demography, extubation time, expiratory tidal volume, peak airway pressures, incidence of post-operative respiratory complications and Bruggeman comfort score (0,10, 20 & 30 mins intervals). Results: The two groups were demographically comparable in terms of age, sex, and BMI. Extubation time showed no significant difference between groups (P = 0.0756). However, the Semi-Fowler’s group demonstrated significantly higher expiratory tidal volumes (P = 6.22 × 10⁻⁹) and peak airway pressures (P = 1.57 × 10⁻³⁸). Respiratory complications were comparable (P = 0.8337), while patient comfort was significantly better in the Semi-Fowler group at 10 and 30 minutes (P = 0.0382, 0.0463).Overall, the distribution of results was statistically significant with a P-value <0.05. Conclusions: We conclude that the semi-Fowler's position presents a favorable balance of benefits for post-abdominal surgery recovery. While extubation time and overall respiratory complications remained comparable, this position significantly improved both expiratory tidal volume and patient comfort. Although it led to higher peak airway pressures, the overall statistically significant findings (P <0.05) underscore its positive impact on patient outcomes.