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What Safety Precautions Do You Need to Know About Endotracheal Tubes?

There are often respiratory, circulatory, and other problems after general anesthesia tube removal, which can be life-threatening in severe cases. Data has shown that the incidence of serious breathing abnormalities during or after tube removal is 4%-9%, and about 0.19% of cases require re-intubation. If the tube removal is "ideal" after surgery, the patient should have satisfactory ventilation, normal respiratory freedom, complete airway protective reflex, and normal lung function. However, in clinical practice, a small number of patients are unable to completely meet these conditions before tube removal, leading to various respiratory and circulatory function abnormalities.


Preparation before endotracheal tube removal


At the end of the surgery, anesthesia has generally stopped, and the patient has entered the recovery stage. If vital signs are stable, autonomous breathing has recovered satisfactorily, tidal volume is sufficient to meet the needs of the body, and consciousness is gradually clear, then tube removal preparation can begin.


Before endotracheal tube removal, the oral and tracheal secretions should be aspirated from the patient. When aspirating the trachea, a finer and more elastic aspirating tube should be used, and its diameter should not exceed half of the tracheal inner diameter. The suction time should not exceed 30 seconds at a time, to avoid lung atelectasis and suction hypoxia. Repeat this intermittently a few times until the site is clear. Positive pressure ventilation may be required before tube removal, especially for thoracic surgery, to allow the lungs to be adequately inflated.


Timing of endotracheal tube removal


The indicators for tube removal should be based on the patient's postoperative condition and the anesthesiologist's own experience. Generally, when the patient's blood pressure, heart rate, and breathing are stable, especially when breathing is adequate, consciousness is basically clear, and all reflexes have basically recovered to normal, and if muscle relaxants have been used, their effects should have completely disappeared. Non-depolarizing muscle relaxants should be appropriately reversed after their actions have disappeared, and then tube removal can be considered.


Issues to pay attention to during and after endotracheal tube removal


Before removing the endotracheal tube, a mask, laryngoscope, and endotracheal tube should be prepared in case re-intubation is necessary due to any unusual occurrences after tube removal.


Pure oxygen ventilation should be continued for 3-5 minutes or synchronous hand-controlled breathing bag-assisted breathing before removal, to ensure sufficient oxygen reserves.


The gas in the endotracheal tube cuff should be extracted to avoid missing the release of gas, which may cause compression on the vocal cords (the tension in the vocal cords has been restored after the anesthesia has ended), resulting in hoarseness, vocal cord paralysis, or epiglottic cartilage dislocation. The tracheal tube should be removed with its curvature to reduce stimulation to the glottis.


After tube removal, observe the patient's respiratory freedom and any abnormalities that may have occurred before removal. If there is a posterior tongue displacement or tracheal secretions, adjustment and suction should be provided to keep the upper respiratory tract unobstructed.


In the event of difficult breathing after endotracheal tube removal, the pharynx should be observed directly through a laryngoscope, and systemic treatments should be given accordingly.


For patients with difficult airways or for whom intubation before surgery was challenging, various rescue equipment should be prepared in advance, and re-intubation or other appropriate measures should be taken when necessary.

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