To the Editor:
Much effort in the education of anesthesia residents is devoted to learning how and when to intubate and extubate patients' tracheae. To this end, guidelines for endotracheal intubation abound. For the patient with a difficult airway, there is an algorithm describing how best to approach ventilation and intubation .
Miller et al.  reviewed the physiology of extubation and described specific techniques for extubation. In an attempt to provide guidelines for our residents regarding whether to extubate a patient's trachea in the operating room, we devised an algorithm for an approach to extubation (Figure 1). The algorithm is not exhaustive in that it does not include all possible patient, surgical, or anesthetic conditions. Certainly, as with all other algorithms, the clinician's judgment is of utmost importance in the decision of whether to proceed with extubation. It may, however, serve as a useful educational tool for residents in the fine art of removing the endotracheal tube that was so adeptly inserted at the beginning of an anesthetic.
Cynthia A. Lien, MD
Howard Koff, MD
Vinod Malhotra, MD
Farida Gadalla, MD
Department of Anesthesiology; The New York Hospital-Cornell Medical Center; New York, NY 10021
1. Benumof JL. Management of the difficult adult airway. Anesthesiology 1991;75:1087-110.
2. Miller KA, Harkin CP, Bailey PL. Postoperative tracheal extubation. Anesth Analg 1995;80:149-72.