The Art of Anesthesia
One of the things that separates the great from the good anesthetists, is what I call The Art of Anesthesia. It is doing every technique artfully as well as skillfully. And, there is always a reason for everything you do.
The Art of Extubation is slowly deflating the cuff on the tube, comparing the amount you remove from the amount you put in (it will probably be more if you used nitrous oxide), and even deflating it more for a smooth extubation. If you do this right, you rarely have a post-extubation laryngospasm.
In the very rare situation where you may have to reintubate, the tube is intact and you save time in getting a new one ready.
In my practice, it is important that the patients do not buck on the tube, so I take my time with deflating the cuff slowly, let the patient get used to the change in tracheal pressure for a few breaths, then extubate.
I don't work with ICU nurses and do my own extubations, but if I did and had a nurse cut a cuff, we would have a "sit-down" (old Sicilian term) and I could guarantee it would not be done again on one of my patients.
Cowboys and Cowgirls should stay on the farm and not work with people.
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