Anesth Pain Med.  2024 Oct;19(Suppl 1):S49-S60. 10.17085/apm.24006.

Extubation and removal of supraglottic airway devices in pediatric anesthesia

• Igarashi A

• KMID: 2563586
• DOI: http://doi.org/10.17085/apm.24006

Abstract

In pediatric anesthesia, respiratory adverse events often occur during emergence from anesthesia and at the time of endotracheal tube or supraglottic device removal. The removal of airway devices and extubation are conducted either while patients are deeply anesthetized or when patients awaken from anesthesia and have regained consciousness. The airways of children are easily irritated by external stimuli and are structurally prone to collapse, and the timing of both methods of airway device removal is similarly associated with various airway complications, including upper airway obstruction, coughing, or serious adverse events such as laryngospasm and desaturation. In current pediatric anesthesia practice, the choice of the timing and method of extubation is made by anesthesiologists. To achieve a smooth and safe recovery from anesthesia, understanding the unique characteristics of pediatric airways and the factors likely to contribute to an increased risk of perioperative complications remains essential. These factors include patient age, comorbidities, and physical conditions. The level of anesthesia and readiness for removal of airway devices should be evaluated carefully for each patient, and quick identification of airway problems and intervention is required if patients fail to maintain the airway and sufficient ventilation after removal of airway devices.

Keyword

Anesthesia; Airway management; Pediatric; Tracheal extubation; Complications; Deep; Awake

Figure

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  Fig. 1. Checklist before awake or deep removal of airway devices. CPAP: continuous positive airway pressure, Et: end-tidal, MAC: minimal alveolar concentration, Sevo:sevoflurane, TOF: train-of-four.

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  Fig. 2. Flowchart for deciding the method of airway device removal. ENT: ear nose and throat, GERD: gastroesophageal reflux disease.

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