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Anaes TopicsExtubation & recovery

Anaes · Extubation & recovery

Extubation & recovery

Also known as Extubation · Emergence · Laryngospasm · Post-extubation stridor · Airway exchange catheter · Staged extubation · Post-anaesthesia care unit · PACU

The extubation and the recovery are the high-risk phases of the anaesthetic that close the perioperative airway and the consciousness. The framework rests on the recognition of the extubation as the high-risk airway event (the DAS extubation guidelines), the extubation criteria, the awake versus the deep extubation, the extubation of the difficult airway (the planned, the staged, the airway-exchange-catheter, the leak test), the laryngospasm and the post-extubation stridor, the emergence and the emergence agitation, and the recovery-room (the PACU) management of the common complications (the PONV, the pain, the shivering, the hypoxaemia) and the discharge.

medium8 referencesUpdated 26 July 20268 min readVerification in progress

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Red flags

  • The extubation is the high-risk airway event — the complications (the laryngospasm, the obstruction, the negative-pressure pulmonary oedema, the hypoxaemia) cluster at the extubation and the emergence, with the airway loss the catastrophic risk. The difficult-airway extubation is the PLANNED event (the DAS extubation guidelines) — the staged extubation, the airway-exchange-catheter, the team ready, the reintubation plan, never the routine pull.
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Red flags

  • The extubation is the high-risk airway event — the complications (the laryngospasm, the obstruction, the negative-pressure pulmonary oedema, the hypoxaemia) cluster at the extubation and the emergence, with the airway loss the catastrophic risk. The difficult-airway extubation is the PLANNED event (the DAS extubation guidelines) — the staged extubation, the airway-exchange-catheter, the team ready, the reintubation plan, never the routine pull.
The one-line answer

Extubation and recovery are the high-risk phases that close the anaesthetic, and the airway complications — laryngospasm, obstruction, negative-pressure pulmonary oedema, hypoxaemia — cluster here, not at induction. The Difficult Airway Society treats extubation as a planned four-step event (plan, prepare, perform, post-extubation care), the default is to extubate awake, suctioned, reversed and warm, and recovery is a structured handover in a monitored PACU where the common problems — hypoxaemia, pain, postoperative nausea and vomiting, shivering and delayed emergence — are caught and treated before discharge.[7]

Meet the patient

A four-year-old is waking after a sevoflurane anaesthetic for hernia repair. He is thrashing, inconsolable, and not responding to his name; his parents are frightened. The monitor shows a normal saturation and a normal heart rate.[4]

This is emergence agitation, and the first job is to hold the reflex to sedate him and instead exclude the dangerous causes — hypoxia, pain, hypercapnia, a blocked airway — before reaching for a drug. Most of what goes wrong at the end of an anaesthetic is preventable by a planned extubation and a structured recovery, and that is what the topic is built to teach.[7]

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References8ShowHide
  1. [1]Cooper RM, et al. Difficult Airway Society guidelines for the management of tracheal extubation Anaesthesia, 2013.PMID 23298360
  2. [2]Higgs A, et al. Pre-oxygenation before extubation Anaesthesia, 2015.PMID 26152265
  3. [3]Albannai N, et al. Effect of Subhypnotic Dose of Propofol on Respiratory Adverse Events Following Postoperative Tonsillectomy/Adenotosillecomy: A Systematic Review and Meta-Analysis J Clin Med, 2026.PMID 41827489
  4. [4]Wang L, et al. Efficacy of dexmedetomidine in preventing emergence agitation in children undergoing tonsillectomy and/or adenoidectomy: a meta-analysis and systematic review BMC Anesthesiol, 2025.PMID 41469848
  5. [5]Sung TY, et al. Effect of Opioid-Sparing Anesthesia on Postoperative Nausea and Vomiting After Breast Surgery: A Single-Center Randomized Controlled Trial J Clin Med, 2026.PMID 42355627
  6. [6]Miller GC, et al. A Triple-Blinded, Randomized, Controlled Trial Comparing Hydromorphone vs. Fentanyl for Children Undergoing Tonsillectomy Paediatr Anaesth, 2026.PMID 42312422
  7. [7]Popat M, et al. Difficult Airway Society Guidelines for the management of tracheal extubation Anaesthesia, 2012.PMID 22321104
  8. [8]Aldrete JA The post-anesthesia recovery score revisited J Clin Anesth, 1995.PMID 7772368

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