**2.3 Emergence and extubation**

The aim of emergence from anesthesia includes smooth, rapid emergence and extubation; also avoidance of straining, bucking, and coughing, and complete, painfree awakening. Use of lidocaine intra-tracheal before extubation will safeguard against coughing and bucking and repeat scalp block at the end of surgery. A smooth emergence with controlled hemodynamics is vital to prevent hemorrhagic complications and graft thrombosis. The tenuous cerebral blood supply places patients with MMD at increased risk of perioperative morbidity during revascularization procedures because of the hemodynamic changes that may occur throughout induction, maintenance, and emergence. The consensus is to maintain CPP at or above the baseline perioperatively. The principle of neuroanesthesia care such as normotension, normovolemia, norm0-oxygenation, normocapnia, and normothermia; must be implemented during the emergence and post-extubation period.
