• Ryosuke Mihara, Nobuyasu Komasawa, Sayuri Matsunami, and Toshiaki Minami.
• Department of Anaesthesia, Osaka Medical College, Takatsuki, Japan.
• J. Int. Med. Res. 2015 Oct 1; 43 (5): 653-60.

ObjectiveTo evaluate the extraction force generated at different extubation angles using a manikin simulation and a randomized clinical trial.MethodsSimulations were performed on a manikin to assess the force generated at extubation angles of 0°, 30°, 45°, 60°, 90° and 120° relative to the ground. The trial compared extraction force and changes in vital signs in patients undergoing general anaesthesia with tracheal intubation followed by extubation at 60° or 90°.ResultsThe simulation study found that the extubation force was significantly lower at 45° and 60° than at all other extraction angles. In the trial, extubation at 60° resulted in significantly lower extraction force and systolic blood pressure elevation (n = 23) than extubation at 90° (n = 23).ConclusionFindings in a manikin simulation were confirmed by those of a randomized clinical trial, where extubation at 60° required less force than 90°, and was accompanied by less SBP elevation. Extubation at 60° is less invasive than extubation at 90°.© The Author(s) 2015.

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