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  • Print publication year: 2010
  • Online publication date: January 2011

Chapter 25 - ENT surgery

from Section 3 - Specialties


An extubation plan should always be formulated. Extubation in a deep plane of anaesthesia is an advanced technique. One-third of aspiration events occur after extubation. Every extubation technique should ensure minimal interruption in the delivery of oxygen to the patient's lungs, and should extubation fail, ventilation should be achievable with the minimal difficulty or delay. The choice of extubation position reflects a balance between the risks of vomiting post-extubation, and subsequent inhalation and soiling of the lungs, and potential respiratory embarrassment and ease of assisting ventilation. The depth of anaesthesia at the time of extubation is highly important because of the risk of life-threatening laryngospasm. Peri-extubation insertion of a laryngeal mask airway (LMA) is a useful technique for airway maintenance in the recovery period with less airway obstruction and coughing, and higher saturations than either deep or awake extubation. An airway exchange catheter (AEC) is a useful aid.

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Further reading

AhmedZM, VohraA. (2002). The reinforced laryngeal mask airway (RLMA) protects the airway in patients undergoing nasal surgery – an observational study of 200 patients. Canadian Journal of Anaesthesia, 49, 863–866.
Boisson-BertrandD. (1995). Tonsillectomies and the reinforced laryngeal mask. Canadian Journal of Anaesthesia, 42, 857–861.
BrimacombeJR. (2005). Flexible LMA for shared airway. In: BrimacombeJR (Ed.), Laryngeal Mask Airway Principles and Practise. Philadelphia, Elsevier. pp 445–467.
ClarkeMB, ForsterP, CookTM. (2007). Airway management for tonsillectomy: A national survey of UK practise. British Journal of Anaesthesia, 99, 425–428.
CohenD, DorM. (2008). Morbidity and mortality of post-tonsillectomy bleeding: Analysis of cases. The Journal of Laryngology and Otology, 122, 88–92.
CrosbyET, CooperRM, DouglasMJ, et al. (1998). The unanticipated difficult airway with recommendations for management. Canadian Journal of Anaesthesia, 45, 757–776.
LattoIP, VaughnRS. (1997). Difficulties in Tracheal Intubation. 2nd ed. London: WB Saunders.
MasonRA, FielderCP. (1999). The obstructed airway in head and neck surgery. Anaesthesia, 54, 625–628.
National Patient Safety Agency. Reducing the risk of retained throat packs after surgery.
NouraeiSA, GiussaniDA, HowardDJ, SandhuGS, FergusonC, PatelA. (2008). Physiological comparison of spontaneous and positive-pressure ventilation in laryngotracheal stenosis. British Journal of Anaesthesia, 101, 419–423.
OvassapianA. (1996). Management of the difficult airway. In: OvassapianA (Ed.), Fibreoptic Endoscopy and the Difficult Airway. 2nd ed. New York: Lippincott-Raven.
PetersonGN, DominoKB, CaplanRA, et al. (2005). Management of the difficult airway: A closed claims analysis. Anesthesiology, 103, 33–39.
Royal College of Surgeons. (2005). National Prospective Tonsillectomy Audit. London: Royal College of Surgeons. ISBN 1–904096–02–6.
WebsterAC, Morley-ForsterPK, DainS, et al. (1993). Anaesthesia for adenotonsillectomy: A comparison between tracheal intubation and the armoured laryngeal mask airway. Canadian Journal of Anaesthesia, 40, 1171–1177.
WebsterAC, Morley-ForsterPK, JanzenV, et al. (1999). Anesthesia for intranasal surgery: A comparison between tracheal intubation and the flexible reinforced laryngeal mask airway. Anesthesia and Analgesia, 88, 421–425.
WilliamsPJ, BaileyPM. (1993). Comparison of the reinforced laryngeal mask airway and tracheal intubation for adenotonsillectomy. British Journal of Anaesthesia, 70, 30–33.
WilliamsPJ, ThompsettC, BaileyPM. (1995). Comparison of the reinforced laryngeal mask airway and tracheal intubation for nasal surgery. Anaesthesia, 50, 987–989.