It is standard practice for an intubated patient to be extubated awake at the end of the operation. The patient should be given 100 % oxygen and assessed to make sure that they fulfill the following criteria before proceeding to extubation:

• Patient is awake and obeying commands
• Patient demonstrates recovery from neuromuscular blockade with sustained headlift, tongue protrusion and good grip strength
• Patient is breathing spontaneously, maintaining oxygenation and not retaining carbon dioxide

If these criteria are not fulfilled, it is safer to leave the tube in than to risk taking it out too early. However, it sometimes requires confidence to leave the tube in a patient who is coughing vigorously on the tube but is not fully awake.

Taking out the tube too soon in a patient who is not fully conscious may predispose to aspiration and laryngospasm.