Table 2.

Learning points from deep extubation-associated respiratory events

Increased awareness of deep extubation-associated events is needed

Opioids should be administered with caution, especially in patients at elevated risk for apnea and airway obstruction

Patients should have reliable intravenous access prior to deep extubation

In off-site locations, support staff may not know how to assist with respiratory adverse events. Deep extubation in off-site locations should be approached with caution

Attending anesthesiologists should be present with the patient during transport after deep extubation

Providers skilled at managing airway obstruction and laryngospasm should remain with the patient until emergence from anesthesia

Medications for treatment of laryngospasm should be immediately available until emergence from anesthesia

Deep extubation should be approached with caution in patients with airway abnormalities such as micrognathia, or in syndromes that may be associated with difficult airway

Close monitoring during transport and in PACU following deep extubation is essential. Consider capnography if available

Drugs and equipment for treatment of airway obstruction and laryngospasm should accompany the patient during prolonged transport, such as between floors

Patients may appear to remain deeply sedated following deep extubation as a result of hypercapnic respiratory failure. Prolonged emergence should prompt for further evaluation

Airway obstruction associated with deep extubation may result in post-obstructive pulmonary edema

Emergency equipment such as “Anesthesia Help” or “Code Blue” buttons should be tested regularly, and emergency carts in PACU should be stocked appropriately

PACU Post-anesthesia care unit. These learning points are compiled from entries within the Wake Up Safe database and also apply to removal of supraglottic devices under deep anesthesia