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Extubation and emergence

Published on Sep 1, 2015in Anaesthesia & Intensive Care Medicine
· DOI :10.1016/j.mpaic.2015.06.019
Andrew Dalton1
Estimated H-index: 1
(Ninewells Hospital),
Lynsey Foulds1
Estimated H-index: 1
(Ninewells Hospital),
Claire Wallace1
Estimated H-index: 1
(Ninewells Hospital)
Abstract
Abstract Emergence and extubation are times of increased risk during anaesthesia. More complications occur then than at induction. The majority of problems are airway related due to airway obstruction, hypoxia, aspiration, airway trauma or post-obstructive pulmonary oedema. Other problems include a delayed recovery of consciousness, cardiovascular instability and delirium. Prompt identification and treatment of the underlying cause is essential to prevent serious morbidity and mortality. The Difficult Airway Society published extubation guidelines in 2012. These guidelines provide a step-wise approach to extubation in a four-stage approach encompassing planning, preparation, performing and then post-extubation care. The planning phase is aimed at identifying the patients in whom extubation is a higher risk procedure, based on the presence or absence of risk factors and clinical assessment. Preparation includes optimization of the patient and the environment prior to extubation. The performing stage is a guide to maximize the success of the extubation process, while the post-extubation care is aimed at ensuring that safe and appropriate care is ongoing.
  • References (7)
  • Citations (1)
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References7
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#1M. R. Checketts (Dund.: University of Dundee)H-Index: 1
#2Ramana Alladi (Royal College of Anaesthetists)H-Index: 1
Last. Jaideep J. Pandit (University of Oxford)H-Index: 32
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Summary This guideline updates and replaces the 4th edition of the AAGBI Standards of Monitoring published in 2007. The aim of this document is to provide guidance on the minimum standards for physiological monitoring of any patient undergoing anaesthesia or sedation under the care of an anaesthetist. The recommendations are primarily aimed at anaesthetists practising in the United Kingdom and Ireland. Minimum standards for monitoring patients during anaesthesia and in the recovery phase are inc...
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#1R. M. CooperH-Index: 1
#2E. O'SullivanH-Index: 1
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Summary Tracheal extubation is a high-risk phase of anaesthesia. The majority of problems that occur during extubation and emergence are of a minor nature, but a small and significant number may result in injury or death. The need for a strategy incorporating extubation is mentioned in several international airway management guidelines, but the subject is not discussed in detail, and the emphasis has been on extubation of the patient with a difficult airway. The Difficult Airway Society has deve...
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