Ability to Reintubate Should be the Key

G. Ram Volotzky, M.D.

To the Editor

The following is my personal opinion as a response to Mr. Fenn’s question in the June issue of the APSF Newsletter Who Should Extubate the Patient in the PACU?

Extubation is a simple technical maneuver. The timing of extubation requires mature judgment and experience. A critical decision which the anesthesiologist must make is WHEN to extubate.

Premature extubation can eventuate in serious damage to the patient from hypoventilation, respiratory obstruction or aspiration. The decision to extubate requires professional training and experience not less than the professional qualifications to induce anesthesia and to intubate.

A patient is maintained intubated in the recovery room due to prolonged drug effect and/or medical condition. Prior to extubation, a qualified person should make an on-site determination that the condition no longer exists. Extubation by individuals lacking the appropriate qualifications can result in an increased risk for complications or in injury due to unwarranted delay in obtaining assistance when needed.

Extubation outside of the operating room should be done by the same person who is qualified to make the decision and to perform an intubation.

G. Ram Volotzky, M.D.

St. Louis, MO

An Alternate View

To the Editor:

I have heard the question discussed “Who should extubate?” since the early 1970’s.

Extubation of patients in PACU should be done by the RN who is following specific established criteria approved by the Director of the Department of Anesthesia. On arrival of the patient to PACU, an anesthesiologist or CRNA should discuss with the PACU nurse any specific instructions for extubation and any intubation problem. Anesthesia should extubate patients who may have severe respiratory limitations.

The PACU nurse is expected to use professional judgment and communicate with the anesthesia person regarding any patient problems that may be encountered after they have left the room. The PACU nurse is expected to be a specialist in post anesthesia care. Not many hospitals are large enough to have an anesthesia floater available in PACU. Anesthesiologists, CRNA and PACU nurse must work cooperatively with one another and be supportive of one another.

The RN’s in PACU at our hospital have been extubating patients since the early 1970’s.

Utha May Morris, RN CCRN Arnarillo, TX