Respiratory complications associated with tracheal extubationTiming of tracheal extubation and use of the laryngeal mask during emergence from anaesthesia

Abstract

SummarySixty patients were randomly allocated to one of three groups and the incidences of respiratory complications which occurred during emergence from anaesthesia were compared under the following three circumstances: tracheal extubation after the patient had regained consciousness (awake group); tracheal extubation while the patient was still anaesthetised (anaesthetised group); and the use of the laryngeal mask during emergence from anaesthesia (mask group). In the mask group, the laryngeal mask was inserted under deep anaesthesia before tracheal extubation and the lungs were ventilated through the laryngeal mask after tracheal extubation. In the awake group, straining (bucking) occurred in 18 patients and desaturation (arterial oxygen haemoglobin saturation`95%) in two patients. In the anaesthetised group, airway obstruction occurred in 17 patients and desaturation in one of these patients. In the mask group, ventilation through the laryngeal mask was temporarily difficult immediately after tracheal extubation in one patient and coughing occurred before removal of the mask in three patients. No respiratory complications occurred in two patients in the awake group, three patients in the anaesthetised group and 16 patients in the mask group. The incidence of respiratory complications during recovery from anaesthesia was significantly lower in the mask group than in the other two groups (pooled) (p``0.001). Therefore, the use of the laryngeal mask after tracheal extubation decreases the incidence of respiratory complications during recovery from anaesthesia.

Learning to exchange an endotracheal tube for a laryngeal mask prior to emergence

“…Despite published descriptions of this technique [6][7][8][9][10][11][12][13] we were, nevertheless, reluctant to perform airway exchange in the absence of prior experience and without the benefit of direct instruction. A graduated method for learning ETT / LM airway exchange was therefore utilized.…”

“…Placing the LM prior to ETT extubation allows the practitioner to act unhurriedly and helps avert problems should multiple LM insertion attempts be needed. [6][7][8][9][10][11][12][13] We first performed a study of 60 patients in which we assessed LM positioning in orally intubated patients. We recorded the number of LM insertion attempts and also fibreoptically evaluated the quality of LM positioning / malpositioning in the presence of an existing oral ETT.…”

Supraglottic Airway DevicesDiscussion

“…This approach may be particularly helpful in situations in which airway and hemodynamic reflexes are not desired or when surgical incisions prevent the application of the face mask. [75][76][77][78] …”

Tracheal extubation with a laryngeal mask airway and exchange catheter in a patient with a difficult airway

“…[1][2][3][4] This technique is also one of the three advanced extubation methods recommended by the Difficult Airway Society in their recent extubation guidelines. 5 Nevertheless, there is a possibility of losing the airway during the exchange procedure.…”