**7.2 Prepare for unplanned extubation**

Notify the team providing ongoing care if the patient had a difficult airway, and have advanced airway equipment and a surgical airway tray at the patient's bedside in case of an unplanned extubation.

## **7.3 Bailey manoeuvre for extubation**

This manoeuvre can be performed by several ways, but it must be done with an adequate depth of anaesthesia (and muscle relaxation) to minimize the risk of laryngospasm. The patient should be properly positioned and preoxygenated, and the oropharynx should be gently suctioned. A deflated SGA is introduced behind the endotracheal tube, its position is confirmed and its cuff is inflated.

The cuff of the endotracheal tube is deflated and the tube is removed, taking care not to remove the SGA with the tube (**Figure 9**).

#### **7.4 Staged extubation set with wire**

Staged extubation uses a staged extubation wire (**Figure 10**) to maintain continuous airway access and a staged reintubation catheter to facilitate a successful reintubation if required. Soft, tapered and kink-resistant wire is coated in a polymeric jacket to assure minimal irritation while in position [45].

**65**

**8. Conclusion**

*Staged extubation set with wire.*

**Figure 10.**

**Figure 9.** *Bailey manoeuvre.*

Establishing a secure airway in a trauma patient is one of the primary essentials of treatment. Maxillofacial trauma directly impacts on the airway resulting in compromise and hindering attempts to secure the airway and any delays in securing the airway may lead to morbidity and mortality. So, multiple approaches to securing the airway are possible; each has advantages and disadvantages. Every airway manager has a different set of skills, experience and availability of airway equipment, so management details will vary based on these factors. It is useful to understand common facial injury patterns that affect airway management and then consider how each injury pattern will interfere with common emergency airway manoeuvres. The time available to accomplish the task is short and the patient's condition may deteriorate rapidly. Both decision-making and performance are impaired in such circumstances. In this chapter, we discussed the complexity of the situation and presented a treatment approach.

*Airway Trauma: Assessment and Management DOI: http://dx.doi.org/10.5772/intechopen.96894*

**Figure 8.** *Airway exchange catheter.*

*Airway Trauma: Assessment and Management DOI: http://dx.doi.org/10.5772/intechopen.96894*

**Figure 9.** *Bailey manoeuvre.*

*Special Considerations in Human Airway Management*

72 h [44].

inflated.

tube dislodgment.

**7.2 Prepare for unplanned extubation**

in case of an unplanned extubation.

**7.3 Bailey manoeuvre for extubation**

**7.4 Staged extubation set with wire**

care not to remove the SGA with the tube (**Figure 9**).

meric jacket to assure minimal irritation while in position [45].

theater over airway exchange catheters (AEC) (**Figure 8**).

pan facial fracture fixation, prolonged surgery and airway oedema should be kept ventilated in intensive care unit. Extubating patients should be done carefully with all equipment for reintubation ready. Some patients may be extubated in operating

AEC is a long hollow bougie that comes in several sizes and can be placed into the trachea through the tracheal tube. The tracheal tube is then removed, and the AEC left in the airway with the tip at the level of the mid trachea. It is important that the catheter remains above the carina, and it should not be inserted beyond 25 cm in an adult patient. The AEC can then be used in the same way as a bougie to help reintubate the trachea in case of deterioration. It has been used in the recovery unit and on critical care unit after head and neck surgery. Usually, the AEC can be left in for few hours after extubation but is can be tolerated for up to

While transferring the patient to intensive therapy unit (ITU), it is safer to keep the patient asleep with tracheal tube in place, but extra care to be taken to avoid

Notify the team providing ongoing care if the patient had a difficult airway, and have advanced airway equipment and a surgical airway tray at the patient's bedside

This manoeuvre can be performed by several ways, but it must be done with an adequate depth of anaesthesia (and muscle relaxation) to minimize the risk of laryngospasm. The patient should be properly positioned and preoxygenated, and the oropharynx should be gently suctioned. A deflated SGA is introduced behind the endotracheal tube, its position is confirmed and its cuff is

The cuff of the endotracheal tube is deflated and the tube is removed, taking

Staged extubation uses a staged extubation wire (**Figure 10**) to maintain continuous airway access and a staged reintubation catheter to facilitate a successful reintubation if required. Soft, tapered and kink-resistant wire is coated in a poly-

**64**

**Figure 8.**

*Airway exchange catheter.*

**Figure 10.** *Staged extubation set with wire.*
