title: Evaluation of double-lumen endotracheal tube extubation force by extraction angle: a prospective randomized clinical trial.
abstract: OBJECTIVE
  Gentle and noninvasive double-lumen tracheal tube (DLT) extubation is important for both airway and circulatory management, especially after lung resection. We performed a prospective randomized clinical trial comparing DLT extubation force based on 2 different extraction angles.
  
  
  METHODS
  Randomized clinical trial.
  
  
  METHODS
  Operating room.
  
  
  METHODS
  Sixty adult patients scheduled for elective surgery under general anesthesia using DLT with ASA physical status 1 to 3.
  
  
  METHODS
  Sixty patients who underwent lung resection with a DLT were randomly assigned to extraction angles of 60° (30 patients) and 90° (30 patients) relative to the ground.
  
  
  METHODS
  Extubation forces and changes in vital signs were compared between groups. Results were analysed with the Mann-Whitney U test, non-paired t test, and χ(2) test. P<.05 was considered significant.
  
  
  RESULTS
  Less extraction force was needed at 60° compared to 90° (90°, 13.9±2.3 N; 60°; 7.1±2.1 N; P<.001). The rate of increase in systolic and diastolic blood pressure (post-extubation/pre-extubation) was significantly smaller at 60° than at 90° (systolic blood pressure, P<.001; diastolic blood pressure, P=.002).
  
  
  CONCLUSIONS
  Our findings suggest that DLT extubation at 60° requires less force than at 90° and was accompanied by a smaller increase in blood pressure. Thus, extraction at 60° may be less invasive and beneficial for patients undergoing DLT extubation.
authors.affiliation: Department of Anesthesiology, Osaka Medical College, Osaka, Japan.
authors.forename: Haruki
authors.initials: H
authors.lastname: Kido
authors.affiliation: Department of Anesthesiology, Osaka Medical College, Osaka, Japan. Electronic address: ane078@poh.osaka-med.ac.jp.
authors.forename: Nobuyasu
authors.initials: N
authors.lastname: Komasawa
authors.affiliation: Department of Anesthesiology, Osaka Medical College, Osaka, Japan.
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Imajo
authors.affiliation: Department of Anesthesiology, Osaka Medical College, Osaka, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Ueno
authors.affiliation: Department of Anesthesiology, Osaka Medical College, Osaka, Japan.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Minami
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D060666:Airway Extubation / Q000009:adverse effects / Q000379:methods*; D000768:Anesthesia, General / Q000379:methods; D001794:Blood Pressure / Q000502:physiology; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006685:Hoarseness / Q000209:etiology; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation* / Q000379:methods; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology; D011312:Pressure; D011446:Prospective Studies; D055815:Young Adult
keywords: Double lumen tracheal tube; Extraction angle; Extubation force; Randomized clinical trial