A Systematic Approach to Emergence and Extubation
A Systematic Approach to Emergence and Extubation - Flowchart A Systematic Approach to Emergence and Extubation A Systematic Approach to Emergence and Extubation
«Flowchart»

Can this patient be extubated while deeply anesthetized?

Can this patient be extubated while deeply anesthetized?

Can this patient be extubated while deeply anesthetized?

End

End

End

Yes

Yes

Yes

No

No

No


Difficult airway
Difficult intubation
Residual neuromuscular block present
COPD
Full stomach


Recent ingestion of food
Pregnant
Obesity
ESRD on dialysis
Diabetic gastroparesis
Ascites


Difficult airway
Difficult intubation
Residual neuromuscular block present
COPD
Full stomach


Recent ingestion of food
Pregnant
Obesity
ESRD on dialysis
Diabetic gastroparesis
Ascites


Difficult airway
Difficult intubation
Residual neuromuscular block present
COPD
Full stomach


Recent ingestion of food
Pregnant
Obesity
ESRD on dialysis
Diabetic gastroparesis
Ascites


Difficult airway
Difficult intubation
Residual neuromuscular block present
COPD
Full stomach


Recent ingestion of food
Pregnant
Obesity
ESRD on dialysis
Diabetic gastroparesis
Ascites


Recent ingestion of food
Pregnant
Obesity
ESRD on dialysis
Diabetic gastroparesis
Ascites


No residual neuromuscular block
Good airway accessible
Easily intubated
Not at increased risk for regurgitation/aspiration
Normothermic


No residual neuromuscular block
Good airway accessible
Easily intubated
Not at increased risk for regurgitation/aspiration
Normothermic


No residual neuromuscular block
Good airway accessible
Easily intubated
Not at increased risk for regurgitation/aspiration
Normothermic


No residual neuromuscular block
Good airway accessible
Easily intubated
Not at increased risk for regurgitation/aspiration
Normothermic

Can the patient be extubated immediately following surgery and emergence from general anesthesia?

Can the patient be extubated immediately following surgery and emergence from general anesthesia?

Can the patient be extubated immediately following surgery and emergence from general anesthesia?

Yes

Yes

Yes

No

No

No


Awake
Following commands
Breathing spontaneously


Well oxygenated
Not excessively hypercarbic


Fully recovered from neuromuscular blockers


Sustained head lift
Strong hand grip


Awake
Following commands
Breathing spontaneously


Well oxygenated
Not excessively hypercarbic


Fully recovered from neuromuscular blockers


Sustained head lift
Strong hand grip


Awake
Following commands
Breathing spontaneously


Well oxygenated
Not excessively hypercarbic


Fully recovered from neuromuscular blockers


Sustained head lift
Strong hand grip


Awake
Following commands
Breathing spontaneously


Well oxygenated
Not excessively hypercarbic


Well oxygenated
Not excessively hypercarbic
Fully recovered from neuromuscular blockers


Sustained head lift
Strong hand grip


Sustained head lift
Strong hand grip


Hypoxic
Excessively hypercarbic
Hypothermic
Residual neuromuscular block
Unable to protect his or her own airway


Airway swelling
Long surgery in Trendelenburg position
Airway surgery
Received excessive intravenous fluid
Impairment of cough/gag reflex
Brainstem surgery
Intraoperative cerebral ischemic events
Vocal cord paralysis
Inadequate strength


Excessively long surgical procedures
Difficult intubation
Unexplained hemodynamic instability


Hypoxic
Excessively hypercarbic
Hypothermic
Residual neuromuscular block
Unable to protect his or her own airway


Airway swelling
Long surgery in Trendelenburg position
Airway surgery
Received excessive intravenous fluid
Impairment of cough/gag reflex
Brainstem surgery
Intraoperative cerebral ischemic events
Vocal cord paralysis
Inadequate strength


Excessively long surgical procedures
Difficult intubation
Unexplained hemodynamic instability


Hypoxic
Excessively hypercarbic
Hypothermic
Residual neuromuscular block
Unable to protect his or her own airway


Airway swelling
Long surgery in Trendelenburg position
Airway surgery
Received excessive intravenous fluid
Impairment of cough/gag reflex
Brainstem surgery
Intraoperative cerebral ischemic events
Vocal cord paralysis
Inadequate strength


Excessively long surgical procedures
Difficult intubation
Unexplained hemodynamic instability


Hypoxic
Excessively hypercarbic
Hypothermic
Residual neuromuscular block
Unable to protect his or her own airway


Airway swelling
Long surgery in Trendelenburg position
Airway surgery
Received excessive intravenous fluid
Impairment of cough/gag reflex
Brainstem surgery
Intraoperative cerebral ischemic events
Vocal cord paralysis
Inadequate strength


Airway swelling
Long surgery in Trendelenburg position
Airway surgery
Received excessive intravenous fluid
Impairment of cough/gag reflex
Brainstem surgery
Intraoperative cerebral ischemic events
Vocal cord paralysis
Inadequate strength
Excessively long surgical procedures
Difficult intubation
Unexplained hemodynamic instability

The patient requires continued intubation and mechanical ventilation.

The patient requires continued intubation and mechanical ventilation.

The patient requires continued intubation and mechanical ventilation.

COPD, chronic obstructive pulmonary disease; ESRD, end-stage renal disease.

COPD, chronic obstructive pulmonary disease; ESRD, end-stage renal disease.

COPD, chronic obstructive pulmonary disease; ESRD, end-stage renal disease.