All India difficult airway association 2016 guidelines for the management of anticipated difficult extubation

Pankaj Kundra, Rakesh Garg, Apeksh Patwa, Syed Moied Ahmed, Venkateswaran Ramkumar, Amit Shah, Jigeeshu Vasishtha Divatia, Sumalatha Radhakrishna Shetty, Ubaradka S. Raveendra, R. Jeson, Dilip K. Pawar, Ramesh Singaravelu, Sabyasachi Das, Sheila Nainan Myatra

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Extubation has an important role in optimal patient recovery in the perioperative period. The All India Difficult Airway Association (AIDAA) reiterates that extubation is as important as intubation and requires proper planning. AIDAA has formulated an algorithm based on the current evidence, member survey and expert opinion to incorporate all patients of difficult extubation for a successful extubation. The algorithm is not designed for a routine extubation in a normal airway without any associated comorbidity. Extubation remains an elective procedure, and hence, patient assessment including concerns related to airway needs to be done and an extubation strategy must be planned before extubation. Extubation planning would broadly be dependent on preventing reflex responses (haemodynamic and cardiovascular), presence of difficult airway at initial airway management, delayed recovery after the surgical intervention or airway difficulty due to pre-existing diseases. At times, maintaining a patent airway may become difficult either due to direct handling during initial airway management or due to surgical intervention. This also mandates a careful planning before extubation to avoid extubation failure. Certain long-standing diseases such as goitre or presence of obesity and obstructive sleep apnoea may have increased chances of airway collapse. These patients require planned extubation strategies for extubation. This would avoid airway collapse leading to airway obstruction and its sequelae. AIDAA suggests that the extubation plan would be based on assessment of the airway. Patients requiring suppression of haemodynamic responses would require awake extubation with pharmacological attenuation or extubation under deep anaesthesia using supraglottic devices as bridge. Patients with difficult airway (before surgery or after surgical intervention) or delayed recovery or difficulty due to pre-existing diseases would require step-wise approach. Oxygen supplementation should continue throughout the extubation procedure. A systematic approach as briefed in the algorithm needs to be complemented with good clinical judgement for an uneventful extubation.

Original languageEnglish
Pages (from-to)915-921
Number of pages7
JournalIndian Journal of Anaesthesia
Volume60
Issue number12
DOIs
Publication statusPublished - 01-12-2016
Externally publishedYes

Fingerprint

India
Guidelines
Preexisting Condition Coverage
Airway Management
Hemodynamics
Perioperative Period
Goiter
Expert Testimony
Obstructive Sleep Apnea
Airway Obstruction
Intubation
Reflex
Comorbidity
Anesthesia
Obesity
Pharmacology
Oxygen
Equipment and Supplies

All Science Journal Classification (ASJC) codes

  • Anesthesiology and Pain Medicine

Cite this

Kundra, Pankaj ; Garg, Rakesh ; Patwa, Apeksh ; Ahmed, Syed Moied ; Ramkumar, Venkateswaran ; Shah, Amit ; Divatia, Jigeeshu Vasishtha ; Shetty, Sumalatha Radhakrishna ; Raveendra, Ubaradka S. ; Jeson, R. ; Pawar, Dilip K. ; Singaravelu, Ramesh ; Das, Sabyasachi ; Myatra, Sheila Nainan. / All India difficult airway association 2016 guidelines for the management of anticipated difficult extubation. In: Indian Journal of Anaesthesia. 2016 ; Vol. 60, No. 12. pp. 915-921.
@article{9b457a12e2fc427e858edd29faeb1235,
title = "All India difficult airway association 2016 guidelines for the management of anticipated difficult extubation",
abstract = "Extubation has an important role in optimal patient recovery in the perioperative period. The All India Difficult Airway Association (AIDAA) reiterates that extubation is as important as intubation and requires proper planning. AIDAA has formulated an algorithm based on the current evidence, member survey and expert opinion to incorporate all patients of difficult extubation for a successful extubation. The algorithm is not designed for a routine extubation in a normal airway without any associated comorbidity. Extubation remains an elective procedure, and hence, patient assessment including concerns related to airway needs to be done and an extubation strategy must be planned before extubation. Extubation planning would broadly be dependent on preventing reflex responses (haemodynamic and cardiovascular), presence of difficult airway at initial airway management, delayed recovery after the surgical intervention or airway difficulty due to pre-existing diseases. At times, maintaining a patent airway may become difficult either due to direct handling during initial airway management or due to surgical intervention. This also mandates a careful planning before extubation to avoid extubation failure. Certain long-standing diseases such as goitre or presence of obesity and obstructive sleep apnoea may have increased chances of airway collapse. These patients require planned extubation strategies for extubation. This would avoid airway collapse leading to airway obstruction and its sequelae. AIDAA suggests that the extubation plan would be based on assessment of the airway. Patients requiring suppression of haemodynamic responses would require awake extubation with pharmacological attenuation or extubation under deep anaesthesia using supraglottic devices as bridge. Patients with difficult airway (before surgery or after surgical intervention) or delayed recovery or difficulty due to pre-existing diseases would require step-wise approach. Oxygen supplementation should continue throughout the extubation procedure. A systematic approach as briefed in the algorithm needs to be complemented with good clinical judgement for an uneventful extubation.",
author = "Pankaj Kundra and Rakesh Garg and Apeksh Patwa and Ahmed, {Syed Moied} and Venkateswaran Ramkumar and Amit Shah and Divatia, {Jigeeshu Vasishtha} and Shetty, {Sumalatha Radhakrishna} and Raveendra, {Ubaradka S.} and R. Jeson and Pawar, {Dilip K.} and Ramesh Singaravelu and Sabyasachi Das and Myatra, {Sheila Nainan}",
year = "2016",
month = "12",
day = "1",
doi = "10.4103/0019-5049.195484",
language = "English",
volume = "60",
pages = "915--921",
journal = "Indian Journal of Anaesthesia",
issn = "0019-5049",
publisher = "Medknow Publications and Media Pvt. Ltd",
number = "12",

}

Kundra, P, Garg, R, Patwa, A, Ahmed, SM, Ramkumar, V, Shah, A, Divatia, JV, Shetty, SR, Raveendra, US, Jeson, R, Pawar, DK, Singaravelu, R, Das, S & Myatra, SN 2016, 'All India difficult airway association 2016 guidelines for the management of anticipated difficult extubation', Indian Journal of Anaesthesia, vol. 60, no. 12, pp. 915-921. https://doi.org/10.4103/0019-5049.195484

All India difficult airway association 2016 guidelines for the management of anticipated difficult extubation. / Kundra, Pankaj; Garg, Rakesh; Patwa, Apeksh; Ahmed, Syed Moied; Ramkumar, Venkateswaran; Shah, Amit; Divatia, Jigeeshu Vasishtha; Shetty, Sumalatha Radhakrishna; Raveendra, Ubaradka S.; Jeson, R.; Pawar, Dilip K.; Singaravelu, Ramesh; Das, Sabyasachi; Myatra, Sheila Nainan.

In: Indian Journal of Anaesthesia, Vol. 60, No. 12, 01.12.2016, p. 915-921.

Research output: Contribution to journalArticle

TY - JOUR

T1 - All India difficult airway association 2016 guidelines for the management of anticipated difficult extubation

AU - Kundra, Pankaj

AU - Garg, Rakesh

AU - Patwa, Apeksh

AU - Ahmed, Syed Moied

AU - Ramkumar, Venkateswaran

AU - Shah, Amit

AU - Divatia, Jigeeshu Vasishtha

AU - Shetty, Sumalatha Radhakrishna

AU - Raveendra, Ubaradka S.

AU - Jeson, R.

AU - Pawar, Dilip K.

AU - Singaravelu, Ramesh

AU - Das, Sabyasachi

AU - Myatra, Sheila Nainan

PY - 2016/12/1

Y1 - 2016/12/1

N2 - Extubation has an important role in optimal patient recovery in the perioperative period. The All India Difficult Airway Association (AIDAA) reiterates that extubation is as important as intubation and requires proper planning. AIDAA has formulated an algorithm based on the current evidence, member survey and expert opinion to incorporate all patients of difficult extubation for a successful extubation. The algorithm is not designed for a routine extubation in a normal airway without any associated comorbidity. Extubation remains an elective procedure, and hence, patient assessment including concerns related to airway needs to be done and an extubation strategy must be planned before extubation. Extubation planning would broadly be dependent on preventing reflex responses (haemodynamic and cardiovascular), presence of difficult airway at initial airway management, delayed recovery after the surgical intervention or airway difficulty due to pre-existing diseases. At times, maintaining a patent airway may become difficult either due to direct handling during initial airway management or due to surgical intervention. This also mandates a careful planning before extubation to avoid extubation failure. Certain long-standing diseases such as goitre or presence of obesity and obstructive sleep apnoea may have increased chances of airway collapse. These patients require planned extubation strategies for extubation. This would avoid airway collapse leading to airway obstruction and its sequelae. AIDAA suggests that the extubation plan would be based on assessment of the airway. Patients requiring suppression of haemodynamic responses would require awake extubation with pharmacological attenuation or extubation under deep anaesthesia using supraglottic devices as bridge. Patients with difficult airway (before surgery or after surgical intervention) or delayed recovery or difficulty due to pre-existing diseases would require step-wise approach. Oxygen supplementation should continue throughout the extubation procedure. A systematic approach as briefed in the algorithm needs to be complemented with good clinical judgement for an uneventful extubation.

AB - Extubation has an important role in optimal patient recovery in the perioperative period. The All India Difficult Airway Association (AIDAA) reiterates that extubation is as important as intubation and requires proper planning. AIDAA has formulated an algorithm based on the current evidence, member survey and expert opinion to incorporate all patients of difficult extubation for a successful extubation. The algorithm is not designed for a routine extubation in a normal airway without any associated comorbidity. Extubation remains an elective procedure, and hence, patient assessment including concerns related to airway needs to be done and an extubation strategy must be planned before extubation. Extubation planning would broadly be dependent on preventing reflex responses (haemodynamic and cardiovascular), presence of difficult airway at initial airway management, delayed recovery after the surgical intervention or airway difficulty due to pre-existing diseases. At times, maintaining a patent airway may become difficult either due to direct handling during initial airway management or due to surgical intervention. This also mandates a careful planning before extubation to avoid extubation failure. Certain long-standing diseases such as goitre or presence of obesity and obstructive sleep apnoea may have increased chances of airway collapse. These patients require planned extubation strategies for extubation. This would avoid airway collapse leading to airway obstruction and its sequelae. AIDAA suggests that the extubation plan would be based on assessment of the airway. Patients requiring suppression of haemodynamic responses would require awake extubation with pharmacological attenuation or extubation under deep anaesthesia using supraglottic devices as bridge. Patients with difficult airway (before surgery or after surgical intervention) or delayed recovery or difficulty due to pre-existing diseases would require step-wise approach. Oxygen supplementation should continue throughout the extubation procedure. A systematic approach as briefed in the algorithm needs to be complemented with good clinical judgement for an uneventful extubation.

UR - http://www.scopus.com/inward/record.url?scp=85007489721&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85007489721&partnerID=8YFLogxK

U2 - 10.4103/0019-5049.195484

DO - 10.4103/0019-5049.195484

M3 - Article

VL - 60

SP - 915

EP - 921

JO - Indian Journal of Anaesthesia

JF - Indian Journal of Anaesthesia

SN - 0019-5049

IS - 12

ER -