title: Difficult extubation: calming the sympathetic storm.
abstract: Tracheal extubation can evoke an equally strong haemodyamic stress response as tracheal intubation. We present a patient with myocardial infarction who repeatedly failed tracheal extubation. He developed acute pulmonary oedema following each attempt at tracheal extubation due to sympathetic overactivity. A change of approach with extubation under propofol sedation followed by continued sympatholysis with dexmedetomidine infusion allowed successful extubation.
authors.affiliation: Intensive Care Unit, The St. George Hospital, Sydney, New South Wales.
authors.forename: A
authors.initials: A
authors.lastname: Kulkarni
authors.forename: G
authors.initials: G
authors.lastname: Price
authors.forename: M
authors.initials: M
authors.lastname: Saxena
authors.forename: G
authors.initials: G
authors.lastname: Skowronski
mesh_terms: D000368:Aged; D016292:Procedural Sedation; D020878:Device Removal / Q000009:adverse effects* / Q000379:methods*; D020927:Dexmedetomidine; D006801:Humans; D006973:Hypertension / Q000209:etiology; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D007442:Intubation, Intratracheal; D008297:Male; D009203:Myocardial Infarction / Q000150:complications / Q000628:therapy; D015742:Propofol; D011654:Pulmonary Edema / Q000209:etiology / Q000503:physiopathology; D013312:Stress, Physiological / Q000503:physiopathology / Q000628:therapy; D013564:Sympathetic Nervous System / Q000503:physiopathology*; D013610:Tachycardia / Q000209:etiology; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000628:therapy
chemical_list: D006993:Hypnotics and Sedatives; D020927:Dexmedetomidine; D015742:Propofol