Difficulty in extubation

Abstract

S u m m a r y Difficulties in removing the tracheal tube from the trachea are relatively uncommon. We report here a case of difficult extubation which was precipitated by pulling of the pilot balloon and valve assembly in order to dejate the cufl.

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.…”

“…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.…”

Management der Extubation - Einführung, Systematik, Vorbereitung der Extubation, Strategie der Extubation, Information des Patienten und Schlußfolgerung

“…Wenn die Cuffleitung desTubus nicht mit einer Spritze entblockt, sondern abgerissen wird, kann die Luft unter Umständen nicht mehr durch die gedehnte Kunststoffleitung entweichen. Diese falsche Technik verhindert dann eine korrekte und atraumatische Extubation (5). Um den noch geblockten Cuff zu entleeren, sind mehrere Techniken beschrieben (5).…”

“…Diese falsche Technik verhindert dann eine korrekte und atraumatische Extubation (5). Um den noch geblockten Cuff zu entleeren, sind mehrere Techniken beschrieben (5). Die Cuffleitung kann kanüliert, der Cuff entweder unter direkter Sicht oder mittels Punktion von außen entleert werden.…”

The Effects of Nitroglycerine (Ntg) Sublingual Spray to Blunt the Haemodynamic Response to Endotracheal Extubation in Lumbar Disc Surgery

“…Tracheal extubation causes additional transient increase by 10-30% in arterial pressure and heart rate lasting 5-15 min. 1 it is more hazardous in patients with hypertension, myocardial insufficiency or cerebral vascular diseases. Patient with coronary artery disease experience a 40-50% decrease in ejection fraction.…”