1.17 Extubation

Question 1

Which patients are at high risk of problems during extubation

Patients factors

Answer 1

Patients factors

Obesity
OSA

Severe Cardioresp disease

Reflux

Congen or acquired airway pathology
burns radtx tumour trauma

Bony or soft tissue abnormality

craniofacial / implants c spine

Question 2

Anaesthetic

Answer 2

factors

Repeated intubation attempts

extubation attempts in lighter planes of anaesthesia

Question 3

Surgical factors

Answer 3

Airway surgery
Oedema 
bleeding
tracheomalacia
Swelling
Laryngeal damage

Neck thyroid or dental surgery
- abscess drain / oedema / alter anatomy

Limited or reduced access
wiring fixation guardian sutures

Posterior fossa surgery

Prolong surgery in Trendelenburg

Question 4

Causes of laryngospasm

Answer 4

Presence of blood or secretions in posterior pharynx

Excess stimulation or extubation during light planes

Airway obstruction
oedema
pharyngeal soft tissue collapse

airway irritability
smoker / urti

Regurgitation and aspiration stomach content

Pain

Other
vagal trigem splanchnic phrenic n stim

Question 5

Stepwise Mx of larnygospasm

Answer 5

1 ABC approach call for help

Primary oxygenation 100% O2

Suction airway remove secretions blood

Oro / NPA

jaw thrust

CPAP with Mapleson c circuit

Consider Larson manoeuvre
Combo
jaw thrust direct medial finger tip pressure posterior to TMJ

Administer propofol bolus
~20% induction dose

IV sux 0.5-1mg/kg

Intubate and ventilate

FONA if failure to oxygenate via standard