If a cuffed tracheal tube has been inserted, remember to remove the air from the cuff before removing the tube. Some anaesthetists close the APL valve and squeeze the reservoir bag immediately before extubation, in an attempt to propel secretions upwards and further minimize the risk of aspiration and also to ensure the patient has a breath of oxygen prior to the tube being removed. Remove the tube gently along its natural curve to avoid damaging laryngeal tissues.

When the tracheal tube has been removed, administer supplemental oxygen and continue this both during transfer, and in the recovery ward.

Extra oxygen administration helps prevent diffusion hypoxia. This may happen if the patient breathes room air after an anaesthetic where nitrous oxide has been given. It occurs because nitrous oxide diffuses out into the alveoli to a greater extent than nitrogen enters the pulmonary capillary blood, thus diluting the alveolar concentration of oxygen.