The art of deep extubation

27.07.2017
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Fair warning — this post is likely to be of interest only to professionals who administer anesthesia or may have to deal with laryngospasm in emergency situations.

There are two schools of thought about how to extubate patients at the conclusion of general anesthesia:

Allow the patient to wake up with the endotracheal tube in place, gagging on the tube and flailing like a fish on a line, while someone behind the patient’s head bleats, “Open your eyes! Take a deep breath!”

Or:

Remove the endotracheal tube while the patient is still sleeping peacefully, which results in the smooth emergence from anesthesia like waking from a nap.
 

It will not require much subtlety of perception to guess that I prefer option 2. It is quiet, elegant, and people who’ve seen it done properly often remark that they would prefer to wake from anesthesia that way, given the choice.

There is art and logic to it, which I had the pleasure of learning from British anesthesiologists at the Yale University School of Medicine years ago. Here are time-tested steps:

Frequently asked questions

Is deep extubation dangerous?

What if the patient goes into “Stage 2” on the way from the OR to PACU?

What about the risk of laryngospasm?

How should complete laryngospasm be managed?

Why bother with deep extubation when awake is easier?

Image copyright: fill/pixabay/CC0

Article last time updated on 01.08.2017.

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