Emergence in Pediatric Anesthetic Practice

Emergence in Pediatric Anesthetic Practice

The decision to extubate the trachea while deeply anesthetized, or after emergence, must be made individualized. In some circumstances, children are allowed to regain their airway reflexes and are extubated awake. However, extubation during deep anesthesia and emergence without an endo-tracheal tube in place is a common practice in pediatric anesthesia. Advantages to awake extubation include the ability to protect against aspiration of stomach contents or blood/secretions from the airway, and the relative safety of passing through stage 2 with an endotracheal tube in place. Advantages of extubation during deep anesthesia include no coughing or straining against suture lines or incisions and removal of the endotracheal tube before it leads to airway reactivity, both of which lead to a smoother emergence. The child then emerges in the operating room or in the recovery room, and meticulous attention is needed to ensure that laryngospasm or airway obstruction does not go undetected during or after transfer to the post anesthesia care unit.