Tracheal Extubation Strategies and Follow-Up Care
When laryngeal edema formation is already present, it requires some time to resolve. We highly recommend that in these patients tracheal extubation should be carefully planned (23), strongly considering either by a delayed or at least a staged tracheal extubation strategy, for example, by using a ventilating airway exchange catheter for reversible tracheal extubation (18).
Video laryngoscopes may also be used for tracheal extubation. They allow improved airway evaluation and tracheal reintubation under visual control when necessary. Bleeding into deep neck structures, particularly after thyroid surgery, may damage recurrent laryngeal nerves; these lesions may be easily identified and documented by videolaryngoscopy.
We further highly recommend that patients with difficult tracheal intubation should be routinely observed for complaints and potentially severe complications associated with difficult airway management (23). Domino and co-workers (9) found that early signs of esophageal and tracheal perforations, pneumothorax and/or subcutaneous emphysema, occurring in the immediate postoperative period were present in only about 50 percent of the perforations, whereas late sequelae, retropharyngeal abscess, mediastinitis, or mediastinal abscess, occurred in 65 percent.
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