Paul, we all respect your extensive experience and yes, you say my personal preference is to extubate in the OR...

Extubation practices can influence how the whole operating room runs. Then - especially if you are in private practice perhaps you want to know if it is safe enough So if one can argue Recovery Room extubation is safe enough then in routine cases it should be the way to go, with exceptions as needed.   

Ivan Hronek MD

On Jul 2, 2009, at 5:55 AM, Paul Kempen <kmpnpm@yahoo.com> wrote:

The LITA tube is an expensive way to perform the "Kempen technique" of lidocaine installation via any  existing ETT. That LITA ETT has an injection port just above the cuff, and you must have one of these expensive tubes in place to do the lidocaine injection. My technique uses only ANY Standard ETT as the mode of injection (see last post). 
I have heard the statement: " I have never regretted NOT extubating a patient, but have regretted an extubation". I personally do not agree with this as some signficant pertubations can be caused by an in situ ETT. Also, although we take great care in trying to "minimize hemodynamic pertubations at intubation" the area regarding minimizing hemodynamic and respiratory pertubations at EXTUBATION is often deemed a "fact of life" or otherwise acceptable consequence of avoiding laryngospasm by waiting till awake.  I routinely assess the airway during induction for the purpose of eliminating the ETT as soon as practical. LIdocaine will obliterate the stimulus, which can become the cause of reflex=laryngospasm! Traveling down the hallway to a distant PACU with an ETT or even LMA can lead to significant hemodynamic and ventlatory pertubations in an unanesthetized airway. Hence my personal preference to extubate as soon as possible in the OR and observe to
assure airway patency in the spontaniously ventilating patient-some jaw thrust can be required! At the same time if agent is eliminated early and after the ETT tracheal tissues have been anesthetized, you can typically go to very minimal level of anesthesia (i.e. N2O alone) or emerge the patient to "open your eyes and stick out your toung" to then pull  the ETT without any pertubation. The great thing is the ability to assess the numbness vie "the cuff Test" while the ETT is still in and airway assurred!
Gotta try it to appreciate it. The key is hjaving a good 3 liter of gass pass up through the cords while actively bagging at a pressure of 20-30 minimum to carry the slowly injected 5 cc of 2% lidocaine up from the tip of the ETT toward the tounge!

P Kempen
Cleveland