Extubating the difficult airway: A protocol for timing and not burning bridges

Francisca Llobell, M.D.1, Patricia Marzal, M.D.1, Luis Gonzalez, M.D.1, Lauren K. Hoke B.S.2, Yvon F. Bryan, M.D.2
• Hospital G. U. Marina Alta, Denia (Alicante), Spain 2. Wake Forest University Baptist Medical Center, Winston-Salem, NC

Introduction Results Discussion

•Protocol provided strategy for timing

•Timing extubation in patients with difficult
extubation with the availability of devices
airways (DA’s) is critical
[Insert picture of Case #2 or 3] needed to bridge
•Device choice for delaying or bridging extubation
•Protocol allowed for versatility in
depends on urgency and potential problems
managing various patient conditions
encountered after extubation
•Further research required in establishing
•We present our initial experience with a protocol
extubation protocols for DA’s
used for extubating patients with DA’s

Methods Abstract
•Protocol combines timing of extubation with
availability of necessary devices Title: Extubating the difficult airway: A protocol for timing and not burning bridges

Francisca Llobell, M.D., Patricia Marzal, M.D., Luis Gonzalez, M.D., Lauren K Hoke, B.S. and Yvon F
Bryan, M.D.. Department of Anesthesiology, Hospital G.U. Marina Alta, Denia, Alicante, Spain.
 
Introduction
Different airway devices may be used to facilitate extubating patients with difficult airways (1, 2).
The timing and devices needed to bridge the extubation, however, depend on the patients
condition and risk. The possibility of aspiration, experiencing potential difficulty with oxygenation
and ventilation and the need for re-intubation are problems frequently encountered. A protocol for
extubation must take into account these problems and combine them with the timing of extubation
and the availability of the necessary airway devices needed to bridge. We present our experience
using a protocol for extubating patients with difficult airways.
 
Methods
The protocol for extubating patients with difficult airways combined the timing (immediate versus
delayed) of extubation with the availability of the necessary airway devices required for bridging
(see Figure 1). A table of airway devices set up according to their function was used for the
patients (3).
 
Results
No complications occurred in any patients in which the protocol was used (see Table 1).
 
Discussion
The extubation protocol provided a strategy for timing the extubation with the necessary airway
devices needed to bridge the extubation. The protocol was designed to take into account the risks
associated with the patients underlying condition and/or surgical intervention with the airway
device best suited for the patient. By allowing for versatility, the protocol facilitated reassessing the
patients need to remain intubated, to bridge or to delay the extubation. Further studies are needed
in the management of patients with difficult airways during extubation.
 
References
1) Anesth Analg 2007; 105:1357-1362.
2) Anesth. Analg. 2007; 105: 11821185.
3) Llobell F, et al. Euroanaesthesia 2008 Annual Meeting.