HOW TO EXTUBATE Knowing when to extubate is also an important knowledge set. In general, it is best to extubate when a patient is still deeply anesthetized (but with adequate spontaneous respirations) or when the patient is awake and responsive with stable vital signs, good grip and sustained head lift. Adequate reversal of neuromuscular blockade must be established. A patient must also demonstrate adequate spontaneous respiratory function with a vital capacity of greater than 15 mL/kg and a negative inspiratory force of greater than 20 mm Hg. Extubation while the patient is in a light plane of anesthesia or still emerging from anesthesia is avoided because of an increased risk of laryngospasm, the most dreaded complication of extubation.
Regardless of whether a patient is extubated while deeply anesthetized or awake, begin by thoroughly suctioning the patient’s pharynx and mouth in order to decrease the risk of aspiration or laryngospasm. Also, “preoxygenate” the patient with 100% oxygen in case it becomes difficult to establish an airway after the ETT is removed. Untape the ETT and deflate its cuff. Apply a small degree of positive pressure on the air bag to help blow out any secretions you may have missed on first suctioning and suction again. Withdraw the tube on end-inspiration or end-expiration in a single, smooth motion. Apply a face mask to deliver 100% oxygen.