The effect of extraction angle on endotracheal tube extubation force: Simulation and randomized clinical trial.
OBJECTIVE
To evaluate the extraction force generated at different extubation angles using a manikin simulation and a randomized clinical trial.


METHODS
Simulations were performed on a manikin to assess the force generated at extubation angles of 0°, 30°, 45°, 60°, 90° and 120° relative to the ground. The trial compared extraction force and changes in vital signs in patients undergoing general anaesthesia with tracheal intubation followed by extubation at 60° or 90°.


RESULTS
The simulation study found that the extubation force was significantly lower at 45° and 60° than at all other extraction angles. In the trial, extubation at 60° resulted in significantly lower extraction force and systolic blood pressure elevation (n = 23) than extubation at 90° (n = 23).


CONCLUSIONS
Findings in a manikin simulation were confirmed by those of a randomized clinical trial, where extubation at 60° required less force than 90°, and was accompanied by less SBP elevation. Extubation at 60° is less invasive than extubation at 90°.
Department of Anaesthesia, Osaka Medical College, Takatsuki, Japan.
Ryosuke
R
Mihara
Department of Anaesthesia, Osaka Medical College, Takatsuki, Japan ane078@poh.osaka-med.ac.jp.
Nobuyasu
N
Komasawa
Department of Anaesthesia, Osaka Medical College, Takatsuki, Japan.
Sayuri
S
Matsunami
Department of Anaesthesia, Osaka Medical College, Takatsuki, Japan.
Toshiaki
T
Minami
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D060666:Airway Extubation; D000768:Anesthesia, General; D003198:Computer Simulation; D003710:Demography; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D055595:Mechanical Phenomena; D008875:Middle Aged; D011182:Postoperative Care; D055815:Young Adult
Extubation force; extraction angle; randomized clinical trial; simulation