Tracheal extubation generates less interest than tracheal intubation. Research, guidelines and clinical anecdotes tend to focus on airway management at the beginning of anesthesia, and it is rare for the challenges of extubation to receive as much attention.

Despite the focus on intubation, extubation and emergence from general anesthesia are not without risk.

The Royal College of Anesthetists and Difficult Airway Society (DAS) 4th National Audit Project (NAP4) found that almost a third of major airway complications occurred during emergence and in the recovery period.

Two cases resulted in death and one in severe brain injury, and there were 10 emergency surgical airways attempted.

Patients undergoing oral or head and neck surgery accounted for almost 50% of these cases and obesity was a common comorbid condition.

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