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Continuing Education in Anaesthesia, Critical Care & Pain 2008 8(6):214-220; doi:10.1093/bjaceaccp/mkn036
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© The Board of Management and Trustees of the British Journal of Anaesthesia [2008]. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Tracheal extubation

Swati Karmarkar
Consultant Anaesthetist
Manchester Royal Infirmary
Central Manchester and Manchester
Children's University Hospitals
Oxford Road
Manchester
M13 9WL
UK

Seema Varshney
Consultant Anaesthetist
North Manchester General Hospital
Delaunays Road,
Crumpsall
Manchester
M8 5RB
UK
Tel: +44 161 720 2280 Fax: +44 161 720 2460 E-mail: svarshney2006@yahoo.co.uk

The first 150 words of the full text of this article appear below.


Key points

Problems associated with extubation, recovery, and emergence are more common than problems at intubation; many aspects are controversial with no clear guidelines or protocols.
The key to management of all post-extubation airway problems is rapid and effective administration of oxygen.
Intra-cuff local anaesthetic or spray can be used for a smooth emergence.
Laryngospasm is the commonest cause of post-extubation airway obstruction and can be life threatening.
Patients at high risk post-extubation require specific preformulated strategies.

 

Respiratory complications after tracheal extubation are three times more common than complications occurring during tracheal intubation and induction of anaesthesia (4.6% vs 12.6%).1 A closed claims analysis of the American Society of Anesthesiologists database revealed that death or brain damage with induction of anaesthesia decreased from 62% of perioperative claims in 1985–1992 to 35% in 1993–1999. This may reflect widespread adoption of difficult airway guidelines which predominantly address induction of anaesthesia. In contrast, . . . [Full Text of this Article]


   Tracheal extubation: awake or anaesthetized?
 

   Patient position
 

   Timing of extubation
 

   Double-lumen tubes
 

   Biting the tracheal tube during emergence
 

   Where should extubation be performed?
 

   Problems associated with extubation
 
Mechanical causes of difficult extubation

Cardiovascular response

Respiratory complications

Airway obstruction

Post-obstructive pulmonary oedema

Tracheomalacia

Pulmonary aspiration


   Recognizing the high risk patient
 

   Strategies for difficult extubation
 
Substituting a laryngeal mask for a tracheal tube while the patient is still anaesthetized and paralysed

Extubation over a flexible bronchoscope

Use of a tracheal tube exchange catheter (reversible tracheal extubation)

Extubation in the intensive care unit

Predicting unsuccessful extubation

Post-extubation stridor


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