Chapter 17 - Extubation

Summary

An extubation plan should always be formulated. Extubation in a deep plane of anaesthesia is an advanced technique. One-third of aspiration events occur after extubation. Every extubation technique should ensure minimal interruption in the delivery of oxygen to the patient's lungs, and should extubation fail, ventilation should be achievable with the minimal difficulty or delay. The choice of extubation position reflects a balance between the risks of vomiting post-extubation, and subsequent inhalation and soiling of the lungs, and potential respiratory embarrassment and ease of assisting ventilation. The depth of anaesthesia at the time of extubation is highly important because of the risk of life-threatening laryngospasm. Peri-extubation insertion of a laryngeal mask airway (LMA) is a useful technique for airway maintenance in the recovery period with less airway obstruction and coughing, and higher saturations than either deep or awake extubation. An airway exchange catheter (AEC) is a useful aid.