Deep extubation in apneic patient

Urzuz, your points are well taken.

I would agree that "standing around masking the patient for an hour" would indeed be clown-shoes retarded; I was assuming the OP's attending would begin a delayed emergence workup shortly after it was clear the remi was gone.

What are you really arguing - that deep extubation itself makes delayed emergence (if it happens) worse because it delays diagnosis? That makes little sense to me. The answer, of course, regardless of one's airway management technique, is that if the patient isn't awake when you expect them to be awake (crani or no crani) you better dust off your differential and start working it up and figuring it out.

As we've both mentioned, in the neurosurgical arena, a primary objective of the anesthetic is a rapid and predictable wakeup to facilitate an exam. There's no reason that can't be done with a deep extubation.

What I'm taking away from your argument, is that given your concern for delayed emergence after any crani, that deep extubation should never be done at all, because the patient might not wake up, and you'd have to reintubate for a CT.

That stance is defensible, even prudent, but it has nothing to do with whether or not the patient is spontaneously breathing when extubated.

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Deep extubation in apneic patient