Challenges and recommendations for extubation after cesarean delivery

Extubation after cesarean delivery

Abstract

Background and purpose: Extubation is the process of removing the endotracheal tube following general anesthesia and represents a critical moment in perioperative care, especially in pregnant patients undergoing cesarean section. Physiological changes during pregnancy increase the risk of complications during extubation, including rapid desaturation, airway obstruction, aspiration, and the potential need for reintubation. These complications can significantly impact maternal morbidity and prolong hospital stays. The aim of this review is to highlight the specific challenges associated with extubation after cesarean delivery, detail potential complications, and provide guidance for safe and effective extubation practices.

Conclusion: Pregnancy leads to significant changes in the respiratory system such as reduced functional residual capacity, increased oxygen consumption, and airway mucosal edema, all of which heighten risks during extubation. Recommendations for safe extubation include thorough preextubation assessment, ensuring complete neuromuscular recovery, performing a quantitative cuff-leak test, continuous peri-extubation monitoring, and utilizing specialized airway equipment in high-risk scenarios. A multidisciplinary approach initiated early in pregnancy or upon identification of airway concerns is crucial for reducing extubation-related complications and ensuring patient safety. Adherence to recommended guidelines can reduce the risk of complications and contribute to the successful outcome of this procedure.