- You needn't use NMB to intubate someone; so you use NMB because you're weak/lazy?
Yes, anyone here who routinely uses an NMB to intubate is a weak, lazy f*cker!
Seriously though, NMB's are a part of a balanced induction/anesthetic - sure you could intubate off just PPF or gas or whatever, but it's gonna take a lot to get there which they pt may or may not be able to tolerate, and you still have no guarantee the pt is not gonna gag and aspirate. Not really germane to discussion about deep extubation though.
even so, you don't need "a large degree of anesthesia" bc if you topicalize the cords, you can basically pull the tube anytime you want, if you so choose
Well now maybe we're playing a semantics game, but extubating a
light pt with a numb trachea is not really a
deep extubation now is it
.
When I refer to a deep extubation, it's in the classical sense of pulling the tube on someone who still a MAC + of anesthetic on board.
My initial comment was based off my own experience. As a junior resident, I had a hard on for deep extubations 'cuz they were "prettier" since I hadn't yet dialed in my wake-ups. Once you figure out how to wake someone up with a tube in without having them cough/buck/sputter/repeat, the allure of deep extubations kinda falls by the wayside - at least it did for me.
I'll also throw in that extubating deep is no guarantee that the pt will not cough/buck. All it takes is for a few drops of saliva to hit those cords at the wrong time or rolling over that bump on the way to PACU (right during Stage 2 which is real) and you can have an agitated, bucking pt only now there's no airway in place.
I'm not totally against deep extubations, I just think that if that's your default strategy for every pt it stems from a place of either being a) lazy, or b) insecure in your wake-up technique.