Extubation

Extubation

1. Laryngospasm may occur during emergence, especially during the critical period of excitement.
2. In most cases, the trachea is extubated after emergence from anesthesia. Coughing is not a sign that the child is ready for extubation. Instead, children should demonstrate purposeful activity (e.g., reaching for the endotracheal tube) or eye opening before extubation. In the infant, hip flexion and strong grimaces are useful indications of awakening.
3. Alternatively, the trachea may be extubated while the patient is in a deep plane of anesthesia with spontaneous ventilation. This can be done in operations such as inguinal herniorrhaphy where coughing on emergence is undesirable or in patients with reactive airways disease. Extubation under deep anesthesia is not appropriate for the child with a full stomach; a child whose trachea was difficult to intubate or the child who had oral or laryngeal surgery. Clinical judgment is essential.
4. Emergence delirium is a relatively common postanesthetic event and can be difficult to differentiate from pain. Common risk factors include; age (1 to 5years old), surgery type (ENT/ophthalmic procedures), preoperative anxiety, preoperative medication, rapid emergence, and pain. Treatment options after treating pain include early reunion with parents, fentanyl (1 μg/kg), propofol (1 mg/kg), and dexmedetomidine (0.5 μg/kg).