Problems Associated With Tracheal Extubation

Attenuation of hemodynamic responses to endotracheal extubation: A prospective randomised controlled study between two different doses of Verapamil

“…Though tracheal extubation seems to be a benign procedure, multiple studies have shown that it can cause significant increase in BP and HR which may persist till the recovery period. [1][2][3][4][5][6] High degree of sympathetic stimulation, as evidenced by tachycardia, hypertension and increased levels of circulating catecholamines during extubation may prove to be detrimental to their health or to the successful outcome of surgery.Hypertensive subjects exhibit an exaggerated response to laryngoscopy and intubation as well as to awakening and extubation compared to normotensive patients. 7,13,45 Increase in BP, HR and RPP which is a multiple of SBP and HR increases the cardiac workload and the oxygen demand of the myocardium; increasing the risk of developing a fresh episode of myocardial ischemia and infarction in known patients of ischemic heart disease due to a fixed coronary blood flow, along with fall in cardiac index and ejection fraction.…”

“…7,13,45 Increase in BP, HR and RPP which is a multiple of SBP and HR increases the cardiac workload and the oxygen demand of the myocardium; increasing the risk of developing a fresh episode of myocardial ischemia and infarction in known patients of ischemic heart disease due to a fixed coronary blood flow, along with fall in cardiac index and ejection fraction. [3][4][10][11][12]16 Therefore, perioperative measurement of RPP is of vital importance.…”

“…Postoperative extubation of trachea is an important event in the course of general anaesthesia which causes a modest (10% to 30%) and transient (lasting approximately 5 to 15 minutes) increase in the HR and BP. [1][2][3][4][5][6][7] Normally these responses are transient in nature hence well tolerated by normotensive healthy subjects.…”

“…[7][8][9][10] Acute hemodynamic changes during extubation can lead to dangerous arrhythmias, 2-4 myocardial ischemia, [3][4]7,[10][11][12][13] acute cardiac failure, 2,5,12 pulmonary edema 8 or cerebrovascular haemorrhage 14 in susceptible individuals. These responses can turn catastrophic in several situations like; ocular surgeries leading to dangerous increase in intraocular pressure; 15 patients with cardiac disease [3][4][10][11][12]16 or intracranial surgeries with raised intracranial pressure or for aneurysm surgeries 14 or with essential hypertension who show an exaggerated response to this stressful event.…”

“…[7][8][9][10] Acute hemodynamic changes during extubation can lead to dangerous arrhythmias, 2-4 myocardial ischemia, [3][4]7,[10][11][12][13] acute cardiac failure, 2,5,12 pulmonary edema 8 or cerebrovascular haemorrhage 14 in susceptible individuals. These responses can turn catastrophic in several situations like; ocular surgeries leading to dangerous increase in intraocular pressure; 15 patients with cardiac disease [3][4][10][11][12]16 or intracranial surgeries with raised intracranial pressure or for aneurysm surgeries 14 or with essential hypertension who show an exaggerated response to this stressful event. 13 A number of attempts have been tried to attenuate these cardiovascular responses; such as extubation in deeper planes of anaesthesia, [17][18] avoiding or reducing duration of laryngoscopy before extubation 19 , use of laryngeal mask airway instead of endotracheal tube, [20][21][22] topical airway anaesthesia with lignocaine, [23][24][25][26] intra-cuff or intravenous lignocaine [27][28] .…”