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Although tracheal intubation receives much attention, especially with regard to management of the difficult airway, tracheal extubation has received relatively little emphasis. The scope and significance of problems occurring after tracheal extubation are real. Adverse outcomes involving the respiratory system comprise the single largest class of injury reported in the ASA Closed Claims Study [1]. Obvious adverse events related to tracheal extubation accounted for 35 of the 522 or 7% of the respiratory-related claims. Certainly additional morbidity related to extubation could be accounted for in other categories of adverse respiratory events, such as inadequate ventilation, airway obstruction, bronchospasm, and aspiration. Others have documented a 4%-9% incidence of serious adverse respiratory events in the immediate postextubation period [2,3] and preventable anesthesia-related etiologies were noted as important by Ruth et al. [2]. Mathew et al. [4], in a retrospective review of more than 13,000 anesthetics, noted that emergency tracheal reintubations occurred in only 0.19% of patients, and that the majority of tracheal reintubations were due to preventable anesthesia-related factors. Perhaps a greater percentage of patients experience postextubation difficulties but do not require reintubation of the trachea. Reasons for tracheal reintubation in the intensive care setting may differ, but the reported incidence in that arena is similarly 4% [5]. Anesthesiologists recognize the immediate postextubation period as one where patients are particularly vulnerable. Events such as laryngospasm, aspiration, inadequate airway patency, or inadequate ventilatory drive can occur and frequently result in hypoxemia. Such hypoxemia is most often postextubation hypoxemia can result in serious review the and with and that can respiratory after tracheal the of extubation for and and for tracheal is not to review the of and tracheal of tracheal with the airway, be in as frequently respiratory after tracheal and such as problems related to the have of and the patients ventilatory a a airway with and the of such as of are in patients after the and extubation respiratory of the that occur in a of the of and the respiratory system are with the airway and of airway such as after tracheal is immediate to airway to ventilatory and hypoxemia in a but often of of the airway after extubation laryngospasm, airway and not be but of by as a can be after a in has to be particularly to of a of the to the can is a to a or the or in can has that can be by a the are of is and that is to of the the and and have that the of the in in a more than Others that of the in to of the of the of the and are by the and of be such 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Published in: Anesthesia & Analgesia
Volume 80, Issue 1, pp. 149-172