This Article Full Text (PDF) Submit a scholarly reply View responses Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Chan, P. B.K. Search for Related Content PubMed PubMed Citation Articles by Chan, P. B.K.

On smooth extubation without coughing and bucking

Hong Kong, China

To the Editor:

Having just received the Journal and read Dr. Orlando Hung's editorial¹ and Dr. Michael Stix et al.'s article² about trying to achieve smooth emergence from anesthesia and extubation (by intra-tracheal lidocaine and exchanging an endotracheal tube (ETT) for a laryngeal mask prior to emergence), I would like to suggest another relatively simple way of achieving such goals.

Whenever I want to extubate a patient quite awake at the conclusion of anesthesia without all the coughing and bucking, I prepare an ETT that will allow me to instil 2% lidocaine into the trachea prior to extubation.

A 3.5 or 5 F.G. infant feeding tube is secured at it's distal tip with about 6 cm length of 1 cm "Micropore" tape to the ETT one cm above the cuff, with the end hole of the feeding tube free from obstruction. The feeding tube is then wound around the ETT snugly and the upper part of the feeding tube is secured again with 1 cm "Micropore" tape to the upper part of the ETT, at the 22 or 24 cm mark of the ETT.

While the patient is still paralyzed or in a deep anesthetic state, I can instill 4 mL of 2% lidocaine through the infant feeding tube, wait a few seconds, then deflate the ETT cuff to let the lidocaine run down into the trachea below the ETT cuff, ventilate the patient once with the cuff still deflated, then re-inflate the cuff. This should provide adequate topical anesthesia to the trachea for about 15 to 20 min. If time to extubate has gone beyond 15 min, repetition of the above manoeuvre before the 20 min "deadline" is up will extend the "tracheal anesthesia" state.

This method has served me well over the last few years. I have learned to time the instillation of lidocaine, so that when the patient is awake enough to be safely extubated, the trachea is still anesthetized topically. A word of caution is warranted. All the suctioning of the oropharynx should be completed before reversing or lightening anesthesia as the oropharynx is not anesthetized topically. Also I have not used this method yet in patients intubated nasotracheally.

View larger version (99K): [in this window] [in a new window]   FIGURE Endotracheal tube with feeding tube.

1 Hung O. Understanding hemodynamic responses to tracheal intubation (Editorial). Can J Anesth 2001; 48: 723–6.[Free Full Text]

2 Stix MS, Borromo CJ, Sciortino GJ. Learning to exchange an endotracheal tube for a laryngeal mask prior to emergence. Can J Anesth 2001; 48: 795–9.[Abstract/Free Full Text]

eLetters:

This Article Full Text (PDF) Submit a scholarly reply View responses Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Chan, P. B.K. Search for Related Content PubMed PubMed Citation Articles by Chan, P. B.K.