Technique of Extubation

Technique of Extubation

Spontaneous ventilation breathing of pure oxygen is established before tracheal extubation. As tracheal intubation is preceded by Preoxygenation to fill the functional residual capacity with oxygen, we have to adequately oxygenate before extubation to allow for the longest safe period should breath- holding or laryngospasm occur immediately after tracheal extubation. The effects of neuromuscular blocking drugs should be fully reserved. The oropharynx is suctioned just before tracheal extubation. The endotracheal tube cuff is deflated and the tracheal tube rapidly removed from patient's trachea and upper airway while a positive-pressure breath is delivered to help expel any secretions. The cuff should not remain deflated for any significant period before tracheal extubation because the vocal cords cannot effectively close around the endotracheal tube and supraglottic secretions can be aspirated. Timing tracheal extubation at the peak of inspiration is intended for the following exhalation or cough to eliminate any aspirated secretions from the trachea. After trachea extubation, oxygen is delivered by facemask.