Related Experiment Video
Updated: May 14, 2026
A Structured Approach to Extubation in Mechanically Ventilated Rats
Published on: July 18, 2025
The effect of deep vs. awake extubation on respiratory complications in high-risk children undergoing
Britta S von Ungern-Sternberg1, Kylie Davies, Mary Hegarty
1Department of Anaesthesia and Pain Management, Princess Margaret Hospital for Children, Subiaco, WA 6008, Australia. britta.regli-vonungern@health.wa.gov.au
Insights
Tracheal extubation timing in children undergoing adenotonsillectomy showed no significant difference in overall respiratory complications. Both deep and awake extubation are viable options with close postoperative monitoring for high-risk pediatric patients.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Respiratory Medicine
Background:
- Debate exists on optimal tracheal extubation timing in children at high risk for perioperative respiratory adverse events, especially after adenotonsillectomy.
- Risk factors include recent respiratory infections, eczema, wheezing, cough, asthma history, and passive smoking.
Purpose of the Study:
- To compare perioperative respiratory adverse events in children undergoing elective adenotonsillectomy.
- To evaluate outcomes between deep anesthesia extubation and awake extubation.
Main Methods:
- Prospective, randomized controlled trial involving 100 children (<16 years) with risk factors for respiratory events.
- Participants were randomized to either deep or awake extubation.
- Adverse events monitored included laryngospasm, bronchospasm, coughing, airway obstruction, and desaturation.
Main Results:
- No significant difference in the overall incidence of perioperative respiratory adverse events between deep and awake extubation groups.
- Awake extubation was associated with more persistent coughing (60% vs. 35%).
- Deep extubation showed a higher incidence of airway obstruction requiring intervention (26% vs. 8%).
Conclusions:
- The overall incidence of perioperative respiratory adverse events did not differ significantly between deep and awake extubation in high-risk children.
- Both extubation strategies are acceptable for adenotonsillectomy in these children.
- Close postoperative monitoring is crucial regardless of the extubation technique used.
Context:
There is ongoing debate regarding the optimal timing for tracheal extubation in children at increased risk of perioperative respiratory adverse events, particularly following adenotonsillectomy.
Objective:
To assess the occurrence of perioperative respiratory adverse events in children undergoing elective adenotonsillectomy extubated under deep anaesthesia or when fully awake.
Design:
Prospective, randomised controlled trial.
Setting:
Tertiary paediatric hospital.
Patients:
One hundred children (<16 years), with at least one risk factor for perioperative respiratory adverse events (current or recent upper respiratory tract infection in the past 2 weeks, eczema, wheezing in the past 12 months, dry nocturnal cough, wheezing on exercise, family history of asthma, eczema or hay fever as well as passive smoking).
Intervention:
Deep or awake extubation.
Main Outcome Measure:
The occurrence of perioperative respiratory adverse events (laryngospasm, bronchospasm, persistent coughing, airway obstruction, desaturation <95%).
Results:
There were no differences between the two groups with regard to age, medical and surgical parameters. The overall incidence of complications did not differ between the two groups; tracheal extubation in fully awake children was associated with a greater incidence of persistent coughing (60 vs. 35%, P = 0.028), whereas the incidence of airway obstruction relieved by simple airway manoeuvres in children extubated while deeply anaesthetised was greater (26 vs. 8%, P = 0.03). There was no difference in the incidence of oxygen desaturation lasting more than 10 s.
Conclusion:
There was no difference in the overall incidence of perioperative respiratory adverse events. Both extubation techniques may be used in high-risk children undergoing adenotonsillectomy provided that the child is monitored closely in the postoperative period.
Trial Registration:
Australian New Zealand Clinical Trials Registry: ACTRN12609000387224.
Related Concept Videos
01:24Endotracheal Tube Extubation
Procedure
Extubation removes the endotracheal tube (ETT) from the patient on mechanical ventilation. It requires a well-coordinated, multidisciplinary approach involving physicians, nurses, respiratory therapists, and other healthcare professionals.
01:17Endotracheal Intubation II: Nursing Management
1. Nursing Care of Patients Before Intubation
Before the endotracheal intubation procedure, nurses play an essential role in ensuring the process goes smoothly. The nurses must be familiar with intubation...
01:15Endotracheal Intubation I: Procedure
The ET tube comprises various components, including a standard adaptor to attach a bag-valve-mask (BVM) or ventilator, a cuff, a pilot balloon, and radiopaque markings along its length to measure the insertion distance. The tube sizes...
01:26Endoscopic Studies II: Thoracocentesis
Description
Excess pleural fluid or air may accumulate in some respiratory disorders in the thoracic cavity. To treat pleural effusion, a physician conducts thoracentesis by carefully piercing the chest wall and entering...
01:21Tracheostomy Decannulation
Description of the Procedure
Decannulation refers to the permanent removal of the tracheostomy tube, signaling the resolution of the condition that initially necessitated the tracheostomy. The process requires a well-coordinated interplay between...
01:29Suctioning the Nasopharyngeal Airway
Equipment Required