Extubation of the difficult airway

Your progress

Saved on this device.

Target exams

Red flags

• An airway that was difficult to intubate must be assumed difficult to re-intubate; never extubate such a patient without a written reintubation plan and the difficult-airway tray at the bedside.
• If the patient bites down, coughs vigorously or obstructs on emergence, laryngospasm and negative-pressure pulmonary oedema may follow — the most dangerous extubation complications are airway, not surgical.
• Extubating 'deep' to avoid coughing abolishes the airway reflexes and the ability to cooperate; it is reserved for selected cases and requires an anaesthetist skilled in maintaining the airway.
• Incomplete reversal of neuromuscular blockade is a leading cause of post-extubation airway obstruction and re-intubation — confirm a train-of-four ratio above ninety percent before removing the tube.
• Blood, secretions or surgical swelling in the airway (thyroid, cervical, maxillofacial surgery) threaten obstruction after extubation; inspect directly and have suction running.
• Removing the airway exchange catheter too early forfeits the rescue conduit; keep it in situ until the patient is fully awake, oxygenating and the team is satisfied the airway is safe.