Difficult extubation: calming the sympathetic storm

Anaesth Intensive Care. 2004 Jun;32(3):413-6. doi: 10.1177/0310057X0403200319.

Abstract

Tracheal extubation can evoke an equally strong haemodyamic stress response as tracheal intubation. We present a patient with myocardial infarction who repeatedly failed tracheal extubation. He developed acute pulmonary oedema following each attempt at tracheal extubation due to sympathetic overactivity. A change of approach with extubation under propofol sedation followed by continued sympatholysis with dexmedetomidine infusion allowed successful extubation.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Conscious Sedation*
  • Device Removal / adverse effects*
  • Device Removal / methods*
  • Dexmedetomidine
  • Humans
  • Hypertension / etiology
  • Hypnotics and Sedatives / administration & dosage*
  • Intubation, Intratracheal*
  • Male
  • Myocardial Infarction / complications
  • Myocardial Infarction / therapy
  • Propofol
  • Pulmonary Edema / etiology
  • Pulmonary Edema / physiopathology
  • Stress, Physiological / physiopathology
  • Stress, Physiological / therapy
  • Sympathetic Nervous System / physiopathology*
  • Tachycardia / etiology
  • Ventricular Dysfunction, Left / complications
  • Ventricular Dysfunction, Left / therapy

Substances

  • Hypnotics and Sedatives
  • Dexmedetomidine
  • Propofol