Facilitating Smooth Emergence and Extubation

Facilitating Smooth Emergence and Extubation

Experience and close communication with the surgeon enable the anesthetist to predict the time at which the application of dressings and casts will be complete. In advance of that time, anesthetic vapors have been decreased or even switched off entirely to allow time for them to be excreted by the lungs.

During emergence, it is important to ensure that your patient has fully recovered from muscle relaxants. A reversal agent should be routinely given to patients who have received nondepolarizing muscle relaxants unless full reversal can be demonstrated the postoperative plan should include continued intubation and ventilation. The commonest reversal agent we are using are neostigmine .05mg/kg preceded by atropine .02mg/kg or glycopyrolate .01mg/kg. Clinical criteria of adequate recovery and removal of endotracheal tube is open the eyes widely on command, sustain protrusion of the tongue, swallow effectively, sustain a head lift for at least 5 seconds, has an effective cough, produces a sustained hand grip and produce adequate inspiratory force of at least 25 to 30 cm H2O with adequate tidal volume.

To prevent emergence hypertension, arrhythmia, bronchospasm and increased intracranial pressure, extubation of the trachea can be considered during deep anesthesia, and ventilation continued by mask. Deep extubation, extubation while the patient is breathing spontaneously but still anesthetized, is effective if performed in the appropriate patients (not in those at increased risk for aspiration of gastric content and easy to reintubate if necessary) and with the necessary airway management skills. If trachea intubation was difficult at the beginning of the procedure, awake extubation to insure that the patient is capable of breathing spontaneously and maintaining oxygenation and ventilation is recommended. Deep extubation increases the risk for vomiting and aspiration. Intraoperative administration of antiemetic medication and nasogastric tube suctioning may decrease the incidence of emesis during emergence, but they do not guarantee an empty stomach.