Quote from CRHSrn
ok then PASSIN GAS ... enlighten me ...
Stage One anesthesia: slight sedation, slow regular breathing, some amnesia
Stage two anesthesia: period of excitement; unconsciousness, dysconjugate gaze, reflex activity--laryngospasm**, vomiting reflex**
Stage three anesthesia: Split into four planes--
Plane 1--regular breathing, active ocular muscles
Plane 2--eyes immobile, respiratory patterns change to decreased tidal volumes and increased rate, eyes become immobile
Plane 3--Surgical plane/stage of anesthesia--diaphragmatic breathing due to loss of intercostal muscles (muscle relaxant effect of inhaled anesthetics) further decrease in tidal volume with a less than compensatory increase in respiratory rate; end result is arterial carbon dioxide levels will increase; plus there is a diminished response by the chemoreceptors to increase ventilation in response to an increased arterial carbon dioxide level
Plane 4--Dilated pupils, irregular breathing
Stage four anesthesia: cardiovascular and respiratory collapse; don't go here.
So, in a long-winded answer to your question, a patient needs to be in stage three, plane three with unreactive airways, regular ventilatory rate and rhythm. Taking OUT an ETT should pose NO RESPONSE by the airways...no coughing, sputtering, no dreaded laryngospasm or bronchospasm.
The patient should gradually 'breathe off' the anesthetic through the lighter planes and stages of anesthesia ON THEIR OWN WITHOUT ASSISTANCE i.e. as you referred to "bag me for 15 min or so...".
Now, think of the time frame. And my reference point is my main clinical practice. I practice anesthesia in an anesthesia care team, office-based practice, and do locum tenens. My main practice setting is in a busy, large, private facility. Literally, time from rolling out of the operating room with a patient alllll the waaaay dooowwwnn the hhaaaalll to PACU can take realistically 1 minute to even 2 minutes if I'm in one of the farther reaches of the OR. So, when is the patient going through stage 2 anesthesia upon awakening if I extubate deep in the OR and am traveling from OR to PACU??? Probably in the hallway. Do I have equipment to break a laryngospasm between OR 2 and PACU? Probably not, I don't routinely carry an AMBU BAG and/or Sch to treat this improbable complication if I avoid the situation by extubating the patient awake.
Ensuring patient's hemodynamic and ventilatory stability is a KEY requirement BEFORE leaving the OR for PACU or an ICU. Obviously, if I am transporting a critical patient to an intensive care environment these critieria change.
Now, since I've gotten on my soap box, one must consider all of the variables others have presented before....Primarily: the PATIENT and his/her PARTICULAR SITUATION. That will be the primary determinant of what is the SAFEST recourse for extubation whether it be awake or asleep.
Much of what anesthesia providers practice is due to what they are exposed to. The PACU I send my patients to is very busy, quick turnover. I attempt to send patients fairly awake to minimize their workload, speeds up patient discharge in the long-run, surgeons are happily assessing neuro status of back procedures, etc.
PS. I apologize if the prior post was taken as terse. Not the intent. I tire of individuals developing opinions in areas where the lack of knowledge impinges upon true understanding of what a particular situation entails.
I, personally had several misconceptions and misunderstandings cleared up during anesthesia school.