Respiratory and hemodynamic outcomes following exchange extubation with laryngeal mask airway as compared to traditional awake extubation

Abstract

Background:Traditional awake extubation leads to respiratory complications and hemodynamic response which are detrimental in neurosurgery, ENT surgery and patients with comorbidities.Aims:The primary objective was to compare the respiratory complications and hemodynamic stress response between traditional awake extubation of a endotracheal tube (ETT) and that following exchange extubation of ETT by using a laryngeal mask airway (LMA).Settings and Design:This prospective randomized study was conducted in a Tertiary Care Centre in 60 American Society of Anesthesiologists I and II patients coming for general surgery.Materials and Methods:Patients were randomized by permuted blocks into traditional awake extubation group and exchange extubation group. At the end of surgery in traditional group, awake extubation of ETT was done. In exchange group, 0.3 mg/kg propofol was administered, and the ETT was exchanged for a LMA. Awake extubation of LMA was then performed. Respiratory complications such as bucking, coughing, desaturation and the need for airway maneuvers and hemodynamic response were noted in both groups.Analysis Tools:Chi-square test, independent sample t- and paired t-tests were used as applicable.Results:Incidence of respiratory complication was 93.3% in traditional extubation while it was only 36.7% in exchange extubation group (P < 0.001). Hemodynamic response measured immediately at extubation in terms of heart rate, systolic blood pressure (BP), diastolic BP, mean arterial pressure, and rate pressure product were all significantly lesser in exchange group when compared to traditional extubation.Conclusion:Exchange extubation with LMA decreases respiratory complications and hemodynamic stress response when compared to traditional awake extubation.

Deep vs. Awake Extubation and LMA Removal in Terms of Airway Complications in Pediatric Patients Undergoing Anesthesia: A Systemic Review and Meta-Analysis

“…Therefore, these complications might be relevant in terms of the overall complications and affect the quality of recovery. Deep extubation may be recommended for patients with intraocular surgery or cerebral aneurysm with the advantage of hemodynamic stability [ 37 ].…”

Anesthetic management for inhibiting sympathetic activation in an adolescent patient diagnosed with catecholaminergic polymorphic ventricular tachycardia and undergoing left cardiac sympathetic denervation: A case report

“…As extubation itself can also be physically stressful, increasing BP and HR, consideration should be given to smooth extubation by preventing airway irritation and cough in addition to pain control for gentle recovery from anesthesia 29–31 . Several options have been introduced for this, including deep extubation, exchanging the endotracheal tube to a laryngeal mask airway prior to extubation, and limiting unnecessary stimulation on emergence such as the “No‐Touch technique” 30,32,33 . Pharmacologic interventions such as intravenous remifentanil, dexmedetomidine, or lidocaine can be added to facilitate these techniques 30,31,34,35 .…”

“… 29 , 30 , 31 Several options have been introduced for this, including deep extubation, exchanging the endotracheal tube to a laryngeal mask airway prior to extubation, and limiting unnecessary stimulation on emergence such as the “No‐Touch technique”. 30 , 32 , 33 Pharmacologic interventions such as intravenous remifentanil, dexmedetomidine, or lidocaine can be added to facilitate these techniques. 30 , 31 , 34 , 35 Although these are commonly available medications, opioids and dexmedetomidine may worsen bradycardia and hypotension in patients with preexisting low HR and BP, and opioids can also cause PONV, which leads to significant stress.…”

Smooth Emergence from General Anesthesia after Deep Extubation in a Pediatric Patient Diagnosed with Catecholaminergic Polymorphic Ventricular Tachycardia: A Case Report

“…LMA insertion in pediatric patients is associated with less hemodynamic response compared to endotracheal intubation [10]. Furthermore, the removal of LMA is associated with fewer hemodynamic changes compared to extubation of ETT after surgery [11,12]. Considering these factors, it appears that using LMA may offer advantages over ETT in achieving the objective of minimizing hemodynamic responses.…”