Survey about the Extubation Practice among Anaesthesiologists in Kosovo

  • Nehat Baftiu Clinic for Anaesthesiology and Intensive Care, University Clinical Centre of Kosovo, Prishtina, Kosovo
  • Islam Krasniqi Clinic for Anaesthesiology and Intensive Care, University Clinical Centre of Kosovo, Prishtina, Kosovo
  • Кastriot Haxhirexha Clinic for Anaesthesiology and Intensive Care, University Clinical Centre of Kosovo, Prishtina, Kosovo
  • Rudin Domi Clinic for Anaesthesiology and Intensive Care, University Clinical Centre of Kosovo, Prishtina, Kosovo
Keywords: General anaesthesia, Anesthesia recovery, Extubation

Abstract

BACKGROUND: Tracheal extubations may be performed before or after awakening from anaesthesia. The advantage of extubation during anaesthesia may avoid all the unpleasant effects of fully awake extubation such as severe hypertension and tachycardia, malignant dysrhythmias, myocardial ischemia laryngospasm, and cough induced high intraocular and intracranial pressure.

AIM: To show the current practice of performing extubations in Kosovo, as well as the advantage and disadvantage in performing this procedure in an awake patient or inpatient in light anaesthesia.

MATERIAL: This study is conducted at the Regional Hospitals and the University Clinical Center of Kosovo during the year 2015. A questionnaire is given to the anesthesiologists to collect information about the techniques used for extubation, timing and management of extubation.

RESULTS: Based on this survey results that 86% of an anesthesiologist (71) extubate the patients when they are completely awake, while 14% of them (12) prefer to extubate the patients under light anaesthesia. From all anesthesiologists involved in this study, forty of them reported problems during extubation. Complications were related to airway, and they are treated by oxygenation and jaw support, but in rare cases, reintubation were performed.

CONCLUSION: Complications during extubation remain important risk factor while extubation during light anaesthesia can minimise some of them.

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References

Priebe HJ. 19RC2 Airway management at the end of anaesthesia: extubation and related issues, Sunday, 12 June 2011 17:00 - 17:45 Room: Emerald Room. http://www.esahq.org/~/media/ESA/Files/Refresher%20Courses/2011/Airway%20management%20at%20the%20end%20of%20anaesthesia%20Extubation%20and%20related%20issues%20(2011).ashx

Martin KT. EXTUBATION: GUIDELINES AND PROCEDURE by BVE, RRT, RCP p6. www.rcecs.com/myce/pdfdocs/course/v7020.pdf#a. Rassam S, Sandbythomas M, Vaugham RS and Hall JE. Airway management before, during and after extubation:a survey of practice in the United Kingdom and Ireland. Anaesthesia. 2005; 60:995-1001. https://doi.org/10.1111/j.1365-2044.2005.04235.x PMid:16179045

Membership of the Difficult Airway Society Extubation Guidelines Group: Popat M (Chairman), Mitchell V., Dravid R., Patel A., Swampillai C. and Higgs A. Difficult Airway Society Guidelines for the management of tracheal extubation. Anaesthesia. 2012; 67: 318–340. https://doi.org/10.1111/j.1365-2044.2012.07075.x PMid:22321104

Peterson GN, Domino KB, Caplan RA, Posner KL, Lee LA, Cheney FW. Management of the difficult airway: a closed claimsanalysis. Anesthesiology. 2005; 103: 33–9. https://doi.org/10.1097/00000542-200507000-00009 PMid:15983454

American Society of Anesthesiologists Task Force on Managementof the Difficult Airway. Practice guidelines for managementof the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology. 2003; 98:1269–77. PMid:12717151

SIAARTI Task Force on Difficult Airway Management. L'intubazionedifficile e la difficoltà di controllodelle vie aereenell'adulto(SIAARTI). Minerva Anestesiologica. 1998; 64: 361–71. PMid:9835725

Braun U, Goldmann K, Hempel V, Krie C. Airway management.Guidelines of the German Society of Anesthesiology andIntensive Care. Anasthesiologie, Intensivmedizin, Notfallmedizin,Schmerztherapie. 2004; 45: 302–6.

Boisson-Bertrand D, Bourgain JL, Camboulives J, et al. Difficult intubation. French Society of Anesthesia and Intensive Care. Acollective expertise. Annales Francaises D'Anesthesie et de Réanimation. 1996; 15:207–14. https://doi.org/10.1016/0750-7658(96)85047-7

Crosby ET, Cooper RM, Douglas MJ, et al. The unanticipated difficult airway with recommendations for management.Canadian Journal of Anesthesia. 1998; 45:757–76. https://doi.org/10.1007/BF03012147 PMid:9793666

Heidegger T, Gerig HJ, Henderson JJ. Strategies and algorithms for management of the difficult airway. Best Practice & Research Clinical Anaesthesiology. 2005; 19:661–74. https://doi.org/10.1016/j.bpa.2005.07.001

Henderson JJ, Popat MT, Latto IP, Pearce AC. Difficult Airway Society guidelines for management of the unanticipated difficult intubation. Anaesthesia. 2004; 59:675–94. https://doi.org/10.1111/j.1365-2044.2004.03831.x PMid:15200543

Cook TM, Woodall N, Frerk C, Fourth National Audit Project. Major complications of airway management in the UK: resultsof the 4th National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: Anaesthesia. British Journal of Anaesthesia. 2011; 106:617–31. https://doi.org/10.1093/bja/aer058 PMid:21447488

Fletcher GC, McGeorge P, Flin RH, Glavin RJ, Maran NJ. The roleof non-technical skills in anaesthesia: a review of current literature. British Journal of Anaesthesia. 2002; 88:418–29. https://doi.org/10.1093/bja/88.3.418 PMid:11990277

Flin R, Crichton M. Safety at the Sharp End. A Guide to Non-Technical Skills. Farnham, Surrey: Ashgate Publishing Ltd, 2008.

PMCid:PMC2213827

Cooper RM. Extubation and Changing Endotracheal Tubes. In:Hagberg CA, eds. Benumof's Airway Management: Principlesand Practice. Philadelphia: Mosby, 2007:1164–80. https://doi.org/10.1016/B978-032302233-0.50056-1

Calder I, Pearce A. Basic Principles of Airway Management. In: Calder I, Pearce A, eds. Core Topics in Airway Management. Cambridge: Cambridge University Press, 2011: 43–52. PMid:20663116

Jubb P, Ford P. Extubation after anaesthesia: a systematicreview. http://felipeairway.sites.medinfo.ufl.edu/files/2011/04/2009-Jubb.pdf (accessed 07 â„ 12 â„ 2011).

Bell MD. Routine pre-oxygenation – A new 'minimum standard'of care? Anaesthesia. 2004; 59:943–5. https://doi.org/10.1111/j.1365-2044.2004.03971.x PMid:15488049

Duggan M, Kavanagh BP. Pulmonary atelectasis: a pathogenic perioperative entity. Anesthesiology. 2005; 102:838–54. https://doi.org/10.1097/00000542-200504000-00021 PMid:15791115

Hedenstierna G, Edmark L. Mechanisms of atelectasis in theperioperative period. Best Practice & Research Clinical Anaesthesiology. 2010; 24:157–69. https://doi.org/10.1016/j.bpa.2009.12.002

Lumb A. Just a little oxygen to breathe as you go off to sleep…is it always a good idea? British Journal of Anaesthesia. 2007; 99:769–71. https://doi.org/10.1093/bja/aem329 PMid:18006527

Benoît Z, Wicky S, Fischer JF, et al. The effect of increased FIO(2) before tracheal extubation on postoperative atelectasis.Anesthesia and Analgesia. 2002; 95:1777–81. https://doi.org/10.1097/00000539-200212000-00058 PMid:12456458

Lindahl SGE, Mure M. Dosing oxygen: a tricky matter or a pieceof cake? Anesthesia and Analgesia. 2002; 95:147–3. https://doi.org/10.1097/00000539-200212000-00002

Edmark L, Kostova-Aherdan K, Enlund M, Hedenstierna G.Optimal oxygen concentration during induction of generalanesthesia. Anesthesiology. 2003; 98:28–33. https://doi.org/10.1097/00000542-200301000-00008 PMid:12502975

Hardman JG, Wills JS, Aitkenhead AR. Factors determining the onset and course of hypoxemia during apnea: an investigation using physiological modelling. Anesthesia & Analgesia. 2000; 90(3):619-24. https://doi.org/10.1097/00000539-200003000-00022

Bogetz MS, Tupper BJ, Vigil AC. Too much of a good thing: uvular trauma caused by overzealous suctioning. Anesthesia and Analgesia. 1991; 72:125–6. https://doi.org/10.1213/00000539-199101000-00023 PMid:1953833

Evans DP, Lo BM. Uvular necrosis after orotracheal intubation.The American Journal of Emergency Medicine. 2009; 27:631. https://doi.org/10.1016/j.ajem.2008.09.004 PMid:19497485

Quinn A, Woodall N. The End of Anaesthesia and Recovery. In: Cook T, Woodall N, Frerk C, eds. 4th National Audit Project ofthe Royal College of Anaesthetists and the Difficult AirwaySociety. Major complications of airway management in the UK.London: Royal College of Anaesthetists, 2011: 62–70.

Patel RI, Hannallah RS, Norden J, Casey WF, Verghese ST. Emergence airway complications in children: a comparison oftracheal extubation in awake and deeply anesthetized patients.Anesthesia and Analgesia. 1991; 73:266–70. https://doi.org/10.1213/00000539-199109000-00006 PMid:1867418

Kempen P. Extubation in adult patients: who, what, when,where, how, and why? Journal of Clinical Anesthesia. 1999; 11:441–4. PMid:10526820

Parr SM, Robinson BJ, Glover PW, Galletly DC. Level ofconsciousness on arrival in the recovery room and thedevelopment of early respiratory morbidity. Anaesthesia and Intensive Care. 1991; 19:369–72. PMid:1837424

Determination of Sherriff Linda Margaret Ruxton in fatal accident inquiry into the death of Gordon Ewing. http://www.scotcourts.gov.uk/opinions/2010FAI15.html (accessed07 â„ 12 â„ 2011).

Roche N, Durieux P. Clinical practice guidelines: from methodologicalto practical issues. Intensive Care Medicine. 1994; 20:593–601. https://doi.org/10.1007/BF01705730 PMid:7706576

Cook DJ, Greengold NL, Ellrodt AG, Weingarten SR. The relation between systematic reviews and practice guidelines. Annals of Internal Medicine. 1997; 127: 210–6. https://doi.org/10.7326/0003-4819-127-3-199708010-00006 PMid:9245227

Woolf SH, Grol R, Hutchinson A, Eccles M, Grimshaw J. Clinical guidelines: potential benefits, limitations, and harms of clinical guidelines. British Medical Journal. 1999; 318:527–30. https://doi.org/10.1136/bmj.318.7182.527 PMid:10024268 PMCid:PMC1114973

Sigurdsson GH, McAteer E. Morbidity and mortality associated with anaesthesia. Acta Anaesthesiologica Scandinavica. 1996; 40:1057–63. https://doi.org/10.1111/j.1399-6576.1996.tb05623.x

Armitage M, Flanagan D. Improving quality measures in theemergency services. Journal of the Royal Society of Medicine. 2001; 94:S39.

Sanders AB. The development of AHA (American HeartAssociation) guidelines for emergency cardiac care. Respiratory Care. 1995; 40:338–44. PMid:10142406

Thomas RD, Waites JH, Hubbard WN, Wicks M. Cardiopulmonaryresuscitation in a district general hospital: increased successover 7 years. Archives of Emergency Medicine. 1990; 7:200–5. https://doi.org/10.1136/emj.7.3.200 PMid:2152462 PMCid:PMC1285701

McGowan J, Graham CA, Gordon MW. Appointment of aResuscitation Training Officer is associated with improvedsurvival from in-hospital ventricular fibrillation ℠ventriculartachycardia cardiac arrest. Resuscitation. 1999; 41:169–73. https://doi.org/10.1016/S0300-9572(99)00046-5

Helmreich RL. On error management: lessons from aviation.British Medical Journal. 2000; 320:781–5. https://doi.org/10.1136/bmj.320.7237.781 PMid:10720367 PMCid:PMC1117774

Westrum R. Human factors experts beginning to focus onorganizational factors in safety. International Civil AviationOrganization Journal. 1996; 51:6–8.

O'Connor T, Papanikolaou V, Keogh I. Safe surgery, the humanfactors approach. The Surgeon: Journal of the Royal Colleges ofSurgeons of Edinburgh and Ireland. 2010; 8:93–5. https://doi.org/10.1016/j.surge.2009.10.004 PMid:20303890

Shamsai J. A new technique for removal of endotracheal tube. Anesthesia and Analgesia. 2006; 103:1040. https://doi.org/10.1213/01.ane.0000239021.80428.cb PMid:17000831

Chung YH, Chao TY, Chiu CT, Lin MC. The cuff-leak test is a simple tool to verify severe laryngeal edema in patients undergoinglong-term mechanical ventilation. Critical Care Medicine. 2006; 34:409-14. https://doi.org/10.1097/01.CCM.0000198105.65413.85 PMid:16424722

Plaud B, Debaene B, Donati F, Marty J. Residual paralysis after emergence from anesthesia. Anesthesiology. 2010; 112:1013-22. https://doi.org/10.1097/ALN.0b013e3181cded07 PMid:20234315

Vaughan RS. Extubation – Yesterday and today. Anaesthesia. 2003; 58: 949–50. https://doi.org/10.1046/j.1365-2044.2003.03451.x PMid:12969035

Published
2018-02-12
How to Cite
1.
Baftiu N, Krasniqi I, Haxhirexha Кastriot, Domi R. Survey about the Extubation Practice among Anaesthesiologists in Kosovo. Open Access Maced J Med Sci [Internet]. 2018Feb.12 [cited 2020Dec.5];6(2):350-4. Available from: https://www.id-press.eu/mjms/article/view/oamjms.2018.083
Section
B - Clinical Sciences