• Haruki Kido, Nobuyasu Komasawa, Yukihiro Imajo, Takeshi Ueno, and Toshiaki Minami.
• Department of Anesthesiology, Osaka Medical College, Osaka, Japan.
• J Clin Anesth. 2016 Mar 1; 29: 40-5.

Study ObjectiveGentle and noninvasive double-lumen tracheal tube (DLT) extubation is important for both airway and circulatory management, especially after lung resection. We performed a prospective randomized clinical trial comparing DLT extubation force based on 2 different extraction angles.DesignRandomized clinical trial.SettingOperating room.PatientsSixty adult patients scheduled for elective surgery under general anesthesia using DLT with ASA physical status 1 to 3.InterventionsSixty patients who underwent lung resection with a DLT were randomly assigned to extraction angles of 60° (30 patients) and 90° (30 patients) relative to the ground.MeasurementsExtubation forces and changes in vital signs were compared between groups. Results were analysed with the Mann-Whitney U test, non-paired t test, and χ(2) test. P<.05 was considered significant.Main ResultsLess extraction force was needed at 60° compared to 90° (90°, 13.9±2.3 N; 60°; 7.1±2.1 N; P<.001). The rate of increase in systolic and diastolic blood pressure (post-extubation/pre-extubation) was significantly smaller at 60° than at 90° (systolic blood pressure, P<.001; diastolic blood pressure, P=.002).ConclusionsOur findings suggest that DLT extubation at 60° requires less force than at 90° and was accompanied by a smaller increase in blood pressure. Thus, extraction at 60° may be less invasive and beneficial for patients undergoing DLT extubation.Copyright © 2016 Elsevier Inc. All rights reserved.

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