Difficult Airway Society Guidelines for the management of tracheal extubation

Abstract

SummaryTracheal extubation is a high‐risk phase of anaesthesia. The majority of problems that occur during extubation and emergence are of a minor nature, but a small and significant number may result in injury or death. The need for a strategy incorporating extubation is mentioned in several international airway management guidelines, but the subject is not discussed in detail, and the emphasis has been on extubation of the patient with a difficult airway. The Difficult Airway Society has developed guidelines for the safe management of tracheal extubation in adult peri‐operative practice. The guidelines discuss the problems arising during extubation and recovery and promote a strategic, stepwise approach to extubation. They emphasise the importance of planning and preparation, and include practical techniques for use in clinical practice and recommendations for post‐extubation care.

Short-term use of remifentanil during endotracheal extubation for prophylactic analgesia in neurosurgical patients after craniotomy (SURE after Craniotomy Study): a study protocol and statistical analysis plan for a randomised controlled trial

“…Endotracheal extubation is a critical step during postoperative care in neurosurgical patients 9. Pain is common during the extubation period, and is related to complications and adverse outcomes 8.…”

“…By using the patient's self-report pain scale as the pain evaluation method, Gacouin et al 8 found that 45% of patients experienced severe pain at the time of endotracheal extubation. Acute pain during extubation is associated with sympathetic nervous system activation, which could result in respiratory and circulatory instability 9. Therefore, it is reasonable to control pain and stress responses at the time of endotracheal extubation in some high-risk patients, such as those after intracranial surgery.…”

Effect of High-Flow Nasal Cannula versus Conventional Oxygen Therapy for Patients with Thoracoscopic Lobectomy after Extubation

“…Following the guideline of Difficult Airway Society Extubation Guidelines Group [7], the patients were ready for scheduled extubation after tolerating a spontaneous breathing trial in ICU. The decision to extubate was at the discretion of the treating doctors in ICU and no mandatory extubation variables were set.…”

Neuromuscular monitoring: an update

“…The use of a peripheral nerve stimulator to ensure a train-of-four ratio of 0.9 or above is recommended in order to reduce the incidence of postoperative airway complications [55].…”