I'm in the middle of my neuro rotation with many lum lams scheduled. The neurosurgeons here are fast so turnover is "expected" to be fast. Do you guys have your patients spontaneously breathe in the prone position while they're closing up?
I get most of my prone patients back breathing at the end (after fascia closure), titrate in narcotics (if needed) and extubate as soon as they're back supine. Nitrous is your friend with fast turnovers rooms.
Also, if you know how, you can extubate them prone.
Obviously dont do this until you're comfortable with your overall skills but, for the right patient, it can work extremely well (I think there was a paper out of Stanford a few years back that also demonstrated improved hemodynamics with prone extubation compared with flipping back to supine but the details escape me at the moment).