Deep Extubation - Revision history

Sul.h.shin: /* Definition */

2023-12-25T17:08:54Z

Definition

← Older revision		Revision as of 17:08, 25 December 2023
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	== Definition ==		== Definition ==
	Deep extubation occurs when the patient has their ETT or LMA removed while still anesthetized, as opposed to awake extubation, in which the patient is fully awake. A meta-analysis of 1881 pediatric patients showed that deep extubation was associated with reduction of airway complications (odds ratio (OR) 0.56, 95% confidence interval (CI) 0.33⁻0.96, ''p'' = 0.04), cough (OR 0.30, 95% CI 0.12⁻0.72, ''p'' = 0.007) and desaturation (OR 0.49, 95% CI 0.25⁻0.95, ''p'' = 0.04) in children after general anesthesia. However, deep extubation increased the risk of airway obstruction compared with awake extubation (OR 3.38 CI 1.69⁻6.73, ''p'' = 0.0005). No difference was observed in the incidence of laryngospasm and breath-holding between the two groups regardless of airway device.<ref>[https://pubmed.ncbi.nlm.nih.gov/30322192/ Deep vs. Awake Extubation and LMA Removal in Terms of Airway Complications in Pediatric Patients Undergoing Anesthesia: A Systemic Review and Meta-Analysis]</ref>.		Deep extubation occurs when the patient has their ETT or LMA removed while still anesthetized, as opposed to awake extubation, in which the patient is fully awake. A meta-analysis of 1881 pediatric patients showed that deep extubation was associated with reduction of airway complications (odds ratio (OR) 0.56, 95% confidence interval (CI) 0.33⁻0.96, ''p'' = 0.04), cough (OR 0.30, 95% CI 0.12⁻0.72, ''p'' = 0.007) and desaturation (OR 0.49, 95% CI 0.25⁻0.95, ''p'' = 0.04) in children after general anesthesia<ref>[https://pubmed.ncbi.nlm.nih.gov/30322192/ Deep vs. Awake Extubation and LMA Removal in Terms of Airway Complications in Pediatric Patients Undergoing Anesthesia: A Systemic Review and Meta-Analysis]</ref>. However, deep extubation increased the risk of airway obstruction compared with awake extubation (OR 3.38 CI 1.69⁻6.73, ''p'' = 0.0005). No difference was observed in the incidence of laryngospasm and breath-holding between the two groups regardless of airway device..

	== Techniques ==		== Techniques ==

Sul.h.shin at 17:08, 25 December 2023

2023-12-25T17:08:14Z

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	A study of 48 children compared deep extubation with sevoflurane (1.5 MAC) to desflurane (1.5 MAC)<ref>[https://pubmed.ncbi.nlm.nih.gov/12707126/ Tracheal extubation of deeply anesthetized pediatric patients: a comparison of desflurane and sevoflurane]</ref>. The desflurane group showed more coughing episodes, incidence of complications after extubation, higher arousal scores, and narcotic administration in the postanesthesia care unit. No serious complications occured in either group. Readiness for discharge and actual time to discharge were not significantly different between groups.		A study of 48 children compared deep extubation with sevoflurane (1.5 MAC) to desflurane (1.5 MAC)<ref>[https://pubmed.ncbi.nlm.nih.gov/12707126/ Tracheal extubation of deeply anesthetized pediatric patients: a comparison of desflurane and sevoflurane]</ref>. The desflurane group showed more coughing episodes, incidence of complications after extubation, higher arousal scores, and narcotic administration in the postanesthesia care unit. No serious complications occured in either group. Readiness for discharge and actual time to discharge were not significantly different between groups.



	'''Relevant Article Depot:'''		'''Relevant Article Depot:'''
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	[https://pubmed.ncbi.nlm.nih.gov/34046286/ Smooth Extubation Techniques in Pediatric Patients After LeFort I Osteotomy]		[https://pubmed.ncbi.nlm.nih.gov/34046286/ Smooth Extubation Techniques in Pediatric Patients After LeFort I Osteotomy]

	[https://pubmed.ncbi.nlm.nih.gov/~~22755543~~/ ~~Tracheal extubation~~ of ~~deeply anesthetized pediatric patients~~: ~~a comparison~~ of ~~sevoflurane and sevoflurane in combination with low-dose remifentanil~~]		[https://pubmed.ncbi.nlm.nih.gov/35840903/ Complications associated with removal of airway devices under deep anesthesia in children: an analysis of the Wake Up Safe database]

	~~[https://pubmed.ncbi.nlm.nih.gov/10195515/ Tracheal extubation of deeply anesthetized pediatric patients: a comparison of isoflurane and sevoflurane]~~

	~~[https~~:~~//pubmed.ncbi.nlm.nih.gov/12707126/ Tracheal extubation of deeply anesthetized pediatric patients: a comparison of desflurane and sevoflurane]~~		'''References''':

	~~[https://pubmed.ncbi.nlm.nih.gov/35840903/ Complications associated with removal of airway devices under deep anesthesia in children: an analysis of the Wake Up Safe database]~~

Sul.h.shin at 17:07, 25 December 2023

2023-12-25T17:07:09Z

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-{{Stub Notice}}
+== Introduction ==
 [[Depth of Anesthesia]]
 [https://europepmc.org/article/med/22999984 A randomized controlled trial comparing Laryngeal Mask Airway removal during adequate anesthesia and after awakening in children aged 2 to 6 years.]
 [https://www.hindawi.com/journals/arp/2021/8883257/ Smooth Extubation and Smooth Emergence Techniques: A Narrative Review]
 [https://www.bjaed.org/article/S2058-5349(21)00133-5/fulltext#%20 Extubation of children in the operating theatre]

WikiSysop at 20:00, 20 December 2023

2023-12-20T20:00:26Z

← Older revision		Revision as of 20:00, 20 December 2023
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	{{Stub Notice}}		{{Stub Notice}}

			[[Depth of Anesthesia]]

	[https://europepmc.org/article/med/22999984 A randomized controlled trial comparing Laryngeal Mask Airway removal during adequate anesthesia and after awakening in children aged 2 to 6 years.]		[https://europepmc.org/article/med/22999984 A randomized controlled trial comparing Laryngeal Mask Airway removal during adequate anesthesia and after awakening in children aged 2 to 6 years.]

WikiSysop at 19:53, 20 December 2023

2023-12-20T19:53:47Z

← Older revision		Revision as of 19:53, 20 December 2023
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	[https://pubmed.ncbi.nlm.nih.gov/12707126/ Tracheal extubation of deeply anesthetized pediatric patients: a comparison of desflurane and sevoflurane]		[https://pubmed.ncbi.nlm.nih.gov/12707126/ Tracheal extubation of deeply anesthetized pediatric patients: a comparison of desflurane and sevoflurane]

			[https://pubmed.ncbi.nlm.nih.gov/35840903/ Complications associated with removal of airway devices under deep anesthesia in children: an analysis of the Wake Up Safe database]

WikiSysop at 19:51, 20 December 2023

2023-12-20T19:51:14Z

← Older revision		Revision as of 19:51, 20 December 2023
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	[https://pubmed.ncbi.nlm.nih.gov/10195515/ Tracheal extubation of deeply anesthetized pediatric patients: a comparison of isoflurane and sevoflurane]		[https://pubmed.ncbi.nlm.nih.gov/10195515/ Tracheal extubation of deeply anesthetized pediatric patients: a comparison of isoflurane and sevoflurane]

			[https://pubmed.ncbi.nlm.nih.gov/12707126/ Tracheal extubation of deeply anesthetized pediatric patients: a comparison of desflurane and sevoflurane]

WikiSysop at 19:49, 20 December 2023

2023-12-20T19:49:31Z

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	[https://pubmed.ncbi.nlm.nih.gov/22755543/ Tracheal extubation of deeply anesthetized pediatric patients: a comparison of sevoflurane and sevoflurane in combination with low-dose remifentanil]		[https://pubmed.ncbi.nlm.nih.gov/22755543/ Tracheal extubation of deeply anesthetized pediatric patients: a comparison of sevoflurane and sevoflurane in combination with low-dose remifentanil]

			[https://pubmed.ncbi.nlm.nih.gov/10195515/ Tracheal extubation of deeply anesthetized pediatric patients: a comparison of isoflurane and sevoflurane]

WikiSysop at 19:47, 20 December 2023

2023-12-20T19:47:55Z

← Older revision		Revision as of 19:47, 20 December 2023
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	[https://pubmed.ncbi.nlm.nih.gov/34046286/ Smooth Extubation Techniques in Pediatric Patients After LeFort I Osteotomy]		[https://pubmed.ncbi.nlm.nih.gov/34046286/ Smooth Extubation Techniques in Pediatric Patients After LeFort I Osteotomy]

			[https://pubmed.ncbi.nlm.nih.gov/22755543/ Tracheal extubation of deeply anesthetized pediatric patients: a comparison of sevoflurane and sevoflurane in combination with low-dose remifentanil]

WikiSysop at 19:45, 20 December 2023

2023-12-20T19:45:20Z

← Older revision		Revision as of 19:45, 20 December 2023
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	[https://pubmed.ncbi.nlm.nih.gov/23344124/ The effect of deep vs. awake extubation on respiratory complications in high-risk children undergoing adenotonsillectomy: a randomised controlled trial]		[https://pubmed.ncbi.nlm.nih.gov/23344124/ The effect of deep vs. awake extubation on respiratory complications in high-risk children undergoing adenotonsillectomy: a randomised controlled trial]

			[https://pubmed.ncbi.nlm.nih.gov/34046286/ Smooth Extubation Techniques in Pediatric Patients After LeFort I Osteotomy]

WikiSysop at 19:43, 20 December 2023

2023-12-20T19:43:26Z

← Older revision		Revision as of 19:43, 20 December 2023
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	[https://www.bjaed.org/article/S2058-5349(21)00133-5/fulltext#%20 Extubation of children in the operating theatre]		[https://www.bjaed.org/article/S2058-5349(21)00133-5/fulltext#%20 Extubation of children in the operating theatre]

			[https://pubmed.ncbi.nlm.nih.gov/23344124/ The effect of deep vs. awake extubation on respiratory complications in high-risk children undergoing adenotonsillectomy: a randomised controlled trial]