Postoperative tracheal extubation- The sequelae

Abstract

The frequency of problems related to tracheal extubation probably exceeds those related to tracheal intubation. Our study was undertaken to determine the post extubation sequelae and haemodynamic responses during tracheal extubation. The study group consisted of randomly selected 250 adult patients in the age group of 18-65 years, belonging to ASA Grade I, II, III, posted for elective surgery under general anaesthesia. We observed the following; Haemodynamic changes [Heart rate (HR), Mean arterial pressure (MAP) changes] and immediate problems associated with post operative tracheal extubation such as bucking, breath holding, cough, airway obstruction, stridor, sorethroat, vomiting, aspiration, pulmonary oedema, residual paralysis occurring during the first 30 minutes of extubation.The changes in HR and MAP were significant soon after extubation (p<0.00) with HR reaching baseline value at 10 min (p=0.074) whereas MAP continued to be significant(p=0.032) even at 30 min. Incidence of immediate problems associated with postoperative tracheal extubation was 38.4% and these were: Bucking – 26.8%, Breath holding – 4.8%, Persistent cough – 4%, Airway obstruction – 2.4%, Stridor – 0.4%, Sorethroat – 4%, Vomiting – 2.4%. There was no incidence of pulmonary aspiration, pulmonary oedema, residual paralysis. It is concluded that tracheal extubation causes haemodynamic instability and can be associated with detrimental responses.