Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Mar 3:9:810366.
doi: 10.3389/fmed.2022.810366. eCollection 2022.

Tracheal Extubation Under Deep Anesthesia Using Transnasal Humidified Rapid Insufflation Ventilatory Exchange vs. Awake Extubation: An Open-Labeled Randomized Controlled Trial

Jin Qiu  1 , Mian Xie  2 , Jie Chen  1 , Bing Chen  1 , Yuanjing Chen  1 , Xiwen Zhu  1 , Hui Lin  3 , Tao Zhu  4 , Guangyou Duan  1 , He Huang  1
Affiliations

Tracheal Extubation Under Deep Anesthesia Using Transnasal Humidified Rapid Insufflation Ventilatory Exchange vs. Awake Extubation: An Open-Labeled Randomized Controlled Trial

Jin Qiu et al. Front Med (Lausanne). .

Abstract

Background: Tracheal extubation can be associated with several complications, including desaturation, agitation, hypertension, and tachycardia. We hypothesize that the use of transnasal humidified rapid insufflation ventilator exchange (THRIVE) immediately after extubation under deep anesthesia reduces the incidence of these adverse events.

Methods: One hundred patients who underwent elective abdominal surgery under general anesthesia were randomly assigned to undergo tracheal extubation under deep anesthesia employing THRIVE (THRIVE group) or awake extubation (CONTROL group). The primary outcome was the incidence of experiencing desaturation (SpO2 < 90%) at any time during emergence from anesthesia. Secondary outcomes included variations in heart rate and blood pressure, comfort level, bucking, and agitation.

Results: The THRIVE group showed a lower incidence of desaturation than the CONTROL group (12 vs. 54%, OR = 0.22 [95% CI, 0.10-0.49], P < 0.001). Less patients in the THRIVE group experienced a 20% (or more) increase in mean arterial pressure (4 vs. 26%, OR = 0.15 [95% CI, 0.04-0.65], P = 0.002). THRIVE patients did not suffer from agitation or bucking, while in the CONTROL group agitation and bucking occurred in 22 and 58% of the patients, respectively. Additionally, the THRIVE group showed a lower incidence of uncomfortable experience than the CONTROL group (8 vs. 36%, OR = 0.22 [95% CI, 0.08-0.61], P = 0.001).

Conclusion: Tracheal extubation under deep anesthesia using THRIVE decreases the incidence of desaturation and adverse haemodynamic events and increases patient satisfaction. Extubation under deep anesthesia using THRIVE might be an alternative strategy in selected patient populations.

Keywords: THRIVE; awake extubation; deep anesthesia; hypoxia; tracheal extubation.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram of the study. ITT, intention to treat analysis.
Figure 2
Figure 2
Between-group comparison of the number of patients who had desaturation (A) and the minimum SPO2 (B) during the stay in post-anesthesia care unit. ***P < 0.001.
Figure 3
Figure 3
The PaO2 (A), PaCO2 (B), and PH (C) at the time of tracheal extubation and 10 min after THRIVE use for patients in the THRIVE group. ***P < 0.001 compared with before extubation.
Figure 4
Figure 4
Mean arterial pressure (A,B) and heart rate (C,D) at before and 30 s after tracheal extubation in THRIVE and CONTROL group. ***P < 0.001.
Figure 5
Figure 5
Between-group comparison of incidences of blood pressure and heart rate fluctuation, bucking and agitation, and subjective uncomfortable experience. HR, heart rate; MAP, mean arterial pressure, **P < 0.01, ***P < 0.001.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Garla PG, Skaredoff M. Tracheal extubation. Anesthesiology. (1992) 76:1058, 60–1. 10.1097/00000542-199206000-00031 - DOI - PubMed
    1. Fan Q, Hu C, Ye M, Shen X. Dexmedetomidine for tracheal extubation in deeply anesthetized adult patients after otologic surgery: a comparison with remifentanil. BMC Anesthesiol. (2015) 15:106. 10.1186/s12871-015-0088-7 - DOI - PMC - PubMed
    1. Banihashem N, Alijanpour E, Hasannasab B, Zarei A. Prophylactic effects of lidocaine or beclomethasone spray on post-operative sore throat and cough after orotracheal intubation. Iran J Otorhinolaryngol. (2015) 27:179–84. 10.22038/IJORL.2015.3822 - DOI - PMC - PubMed
    1. Miyazaki M, Kadoi Y, Saito S. Effects of landiolol, a short-acting beta-1 blocker, on hemodynamic variables during emergence from anesthesia and tracheal extubation in elderly patients with and without hypertension. J Anesth. (2009) 23:483–8. 10.1007/s00540-009-0805-9 - DOI - PubMed
    1. Kothari D, Tandon N, Singh M, Kumar A. Attenuation of circulatory and airway responses to endotracheal extubation in craniotomies for intracerebral space occupying lesions: dexmedetomidine versus lignocaine. Anesth Essays Res. (2014) 8:78–82. 10.4103/0259-1162.128916 - DOI - PMC - PubMed

LinkOut - more resources