Extubation in Pediatric Patients: Proactive or Passive?
Study Details
Study Description
Brief Summary
Smooth extubation process can reduce the complications in recovery time. This study aimed to investigate what is the better time to extubation when children is breathing spontaneously and adequately: waiting until children have movements or wakefulness (passive extubation）or removing endotracheal tube directly (proactive tracheal extubation).
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
N/A |
Detailed Description
This is a randomized, controlled cross-over trial. The hypothesis of this study is that the different extubation protocol can impact recovery quality in children in post-anaesthesia care unit (PACU). Patients aged 3-7 years were randomized into two equal groups: proactive extubation (Group A) and passive extubation. At the end of surgery, sevoflurane was turned off and patients all delivered into PACU for recovery. Patient was positioned on his or her lateral side. The ventilation was switched to positive airway pressure (CPAP) mode once the patients regained spontaneous respiration. After spontaneous breathing turn to regular and sufficient（tidal volume >6-8 ml/kg, respiratory rate >10 times per minutes , end tidal carbon dioxide concentration >7.19 mmHg）, the trachea tube could be removed. In Group A, patients were extubated in a light plane of anesthesia, when they are still asleep or have swallowing reflex. In Group B, tracheal extubation was performed when the patient regained consciousness, facial grimace, spontaneous eye opening, and purposeful arm movement. After extubation, 2 L/min oxygen was administered with Venturi face mask for 10 min in both groups. Patients were transported to the ward until they breathed air with a patent airway. The extubation time, recovery characteristics and respiratory complication were recorded.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Active Comparator: group A children were extubated in a light plane of anesthesia, when they are still asleep or have swallowing reflex. |
Behavioral: proactive extubation
when children is breathing spontaneously and adequately in PACU,endotracheal tube was removed directly
|
| No Intervention: group B Tracheal extubation was performed when the patient regained consciousness, facial grimace, spontaneous eye opening, and purposeful arm movement. |
Outcome Measures
Primary Outcome Measures
- Coughing [at the time of extubation within 1 minute]
1 if a single cough occurred and saturation by pulse oximetry (SpO2) ≥95%; 2 if multiple coughs occurred and SpO2 ≥95%; 3 if multiple coughs occurred and SpO2 <95%; and 4 if multiple coughs occurred, SpO2 <95%, and coughing required administration of i.v . medication.
- Respiratory complications [During the time when patients stayed in PACU after extubation, an average of 45 min]
the number of patients who had gagging, clenched teeth, gross purposeful movements, breath holding, laryngospasm, or desaturation to SpO2<90%
- Time to spontaneous eye opening [The time from PACU arrival to spontaneous eye opening, an average of 45 min]
Time to spontaneous eye opening
- Time to discharge from PACU [The time from patients arrived PACU to who was decided to discharge from PACU，an average of 1 hour]
Time to discharge from PACU
Secondary Outcome Measures
- Time to extubation [The time from PACU arrival to tracheal extubation, an average of 30 min]
The time of extubation after surgery
- End-tidal concentration of minimum effective alveolar anesthetic concentration [The time before patients were decided to extubate, within 1 minute]
In percentage
- Age [6 hours before intervention]
In years
- Weight [6 hours before intervention]
In kilograms
- Height [6 hours before intervention]
In meters
- Systolic blood pressure [5 minutes before extubation]
Hemodynamic parameter
- Systolic blood pressure [1 minute after extubation]
Hemodynamic parameter
- Systolic blood pressure [5 minutes after extubation]
Hemodynamic parameter
- Diastolic blood pressure [5 minutes before extubation]
Hemodynamic parameter
- Diastolic blood pressure [1 minute after extubation]
Hemodynamic parameter
- Diastolic blood pressure [5 minutes after extubation]
Hemodynamic parameter
- Heart rate [5 minutes before extubation]
hemodynamic parameter
- Heart rate [1 minute after extubation]
hemodynamic parameter
- Heart rate [5 minutes after extubation]
hemodynamic parameter
Eligibility Criteria
Criteria
Inclusion Criteria:
- American Society of Anesthesiologists physical status aged 3-7 years
Exclusion Criteria:
- a suspected difficult airway reactive airway disease, recent upper respiratory tract infection gastrointestinal reflux obesity (body mass index>30 kg/m2
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Anesthesiology Department of Affiliated Eye and ENT Hospital, Fudan University | Shanghai | Shanghai | China | 200031 |
Sponsors and Collaborators
- Eye & ENT Hospital of Fudan University
Investigators
None specified.Study Documents (Full-Text)
None provided.More Information
Publications
- Bidwai AV, Bidwai VA, Rogers CR, Stanley TH. Blood-pressure and pulse-rate responses to endotracheal extubation with and without prior injection of lidocaine. Anesthesiology. 1979 Aug;51(2):171-3.
- Tsukamoto M, Hitosugi T, Yokoyama T. Comparison of recovery in pediatric patients: a retrospective study. Clin Oral Investig. 2019 Sep;23(9):3653-3656. doi: 10.1007/s00784-019-02993-y. Epub 2019 Jul 4.
- Valley RD, Freid EB, Bailey AG, Kopp VJ, Georges LS, Fletcher J, Keifer A. Tracheal extubation of deeply anesthetized pediatric patients: a comparison of desflurane and sevoflurane. Anesth Analg. 2003 May;96(5):1320-1324. doi: 10.1213/01.ANE.0000058844.77403.16.
- A/P extubation