Top tips for extubation
We spend a lot of time focusing on how to induce and intubate our patients safely and efficiently, but relatively little attention seems to be given to the reversal of this process.
When you intubate someone, there are several factors working in your favour to make the whole event a little more predictable:
- You decide when it happens
- You've preoxygenated and got all your kit ready
- You've drawn up all your drugs and emergency meds
- The IV induction drops them down through the planes of anaesthesia nice and quickly
- Assuming you've used muscle relaxation, they're not going to move while you're looking for the cords
Now consider your extubation.
- You have far less control over when the patient wakes up
- They ascend slowly through the planes of anaesthesia, and spend much longer in the high risk 'plane 2' where laryngospasm and breath-holding abound
- The patient can bite down on the tube, or flail around and injure themselves
- How often have you got a full set of induction meds ready to go in case you need to do a go-around?
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Extubation is just as risky as intubation, except you have even less control.
Safe beats smooth
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