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
1. 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
airways (DA’s) is critical extubation with the availability of devices
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
used for extubating patients with DA’s extubation protocols for 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.