- Avoid airway manipulation entirely e.g. perform CEA under local/regional anaesthetic technique
- Avoid endotracheal intubation entirely e.g. use a supraglottic airway device
- Deep exchange of endotracheal tube to supraglottic device
Coughing During Extubation
Coughing During Extubation
Resources
- Coughing during extubation is common, affecting up to three quarters of patients
- A smooth, coughing-free extubation is desirable following a number of (typically head and neck) surgeries, particularly those such as:
- Carotid endarterectomy
- Various ENT and OMFS procedures e.g.thyroid surgery
- Ophthalmic surgery
- Neurosurgery
- There are a variety of described methods to avoid coughing (as well as bucking, straining etc.) on extubation:
- Lidocaine
- IV, intra-cuff, vocal cord topicalisation and trans-tracheal methods are described
- Remifentanil infusion during extubation (e.g. Ce 1-2ng/ml)
- Other short-acting opioid e.g. fentanyl
- Dexmedetomidine
- Is there an optimal agent?
- The above-linked network meta-analysis appears to be the most robust resource attempting to answer this question
- To avoid moderate-severe coughing during extubation, use of any of the above agents is better than placebo or nothing
- The same applies to severe coughing, with the caveat that intra-cuff and trans-tracheal lidocaine are not effective
- None of the agents was definitively superior to any other, although dexmedetomidine was most likely to be the best of the bunch