The newly revised 2013 Practice Guidelines for Management of the Difficult Airway includes Section IV: Considerations for Extubation of the Difficult Airway.1 The following is a summary of extubation principles recommended by the ASA Task Force on Management of the Difficult Airway in the 2003 and 2013 versions of the practice guidelines.1,2
Despite the decade between publication of the 2003 and the current 2013 guidelines, there remains insufficient scientific evidence to assess the benefits of a specific extubation strategy in management of a difficult airway. There is general agreement that a pre-formulated extubation strategy should be considered. These strategies will depend on the surgery, condition of the patient and the skills of the anesthesiologist. Strategies can include the following: merits of an awake versus deep extubation, assessment of factors that may cause difficulty in ventilation post-extubation, and a pre-formulated plan for airway management should the patient...
