In logical sequence, which of these criteria should be met before extubating?
Drag the labels on the right to the corresponding events on the left.
FIRST: A. Confirm neuromuscular function is adequate. This should be your first move. It is distressing for patients to emerge from anaesthesia while still partially paralyzed. Their respiratory function and ability to clear secretions will also be impaired.
SECOND: C. Stop anaesthetics drugs and give 100% oxygen. High flow oxygen (>6 L/min) will speed this process, but it still takes several minutes for washout of the inhaled anaesthetic agents to occur.
THIRD: E. Apply suction to the airway. Patients can’t swallow under anaesthesia. Saliva and other debris will accumulate in the mouth and pharynx and this could be inhaled during emergence. It’s best to do this before the patient is fully awake, to avoid biting on the suction device.
FOURTH: B. Ensure breathing is adequate. The ventilator should be turned off and the reservoir bag observed for the return of spontaneous respiration. Gentle assistance may be required by squeezing the bag manually.
FIFTH: D. Place patient in a suitable recovery position. As we shall see, there are several suitable positions, depending on the circumstances.
SIXTH: F. Assess wakefulness and ability to maintain airway. This is the final consideration. But remember, ‘every extubation is a trial of extubation’ and very occasionally reintubation will be necessary.