Table 4.

Criteria for Safe Extubation

Step 1: Plan extubation

Review the patient's preoperative airway findings

Consider the patient's comorbidities and associated risk factors

Consider surgical factors that may complicate the airway

Step 2: Prepare for extubation

Confirm that the patient is fully reversed from neuromuscular blockade

Train of four >0.9

Sustained hand grasp or head lift

Confirm that patient is adequately oxygenated

SpO2 >94%

Confirm that patient is breathing spontaneously

Respiration rate >8 bpm

Confirm that patient has adequate ventilation

Tidal volume >3–5 mL/kg

EtCO2 < 50 mm Hg

Confirm that the patient is hemodynamically stable

Confirm that the patient has emerged from stage 2 of anesthesia

Conjugate gaze

Pupils are normal

Confirm that the patient is neurologically intact

Patient follows verbal commands

Step 3: Perform extubation

Suction oral cavity and pharynx

Deflate endotracheal cuff

Apply positive pressure while removing endotracheal tube

Step 4: Recovery

Confirm airway patency

Apply 100% supplemental oxygen

Manage the airway as necessary

Monitor the patient's oxygenation and ventilation status

Confirm respiratory stability prior to discharge