Background: extubation has an important role in optimal patient recovery after surgery, but, although
elective, is often fraught with complications. TotalTrack® VLM (Video Laryngeal Mask) (TT VLM) (Medcom
Flow, Spain) allows minimally interrupted ventilation during tracheal intubation and extubation under
continuous video guidance.
Case Report: we report twenty (20) cases of TWO-PHASE extubation plannification with TT VLM in
Supraglottic Device (SAD) mode (1). All patients were ASA 2-3, BMI>30, Arne test>11, with pre-existing
airway concerns, such as difficult mask ventilation, history of difficult intubation, hypertension, ENT
diseases, obstructive sleep apnoea (OSA), etc.
Our objective was a smooth eduction, without hemodynamic alterations, without respiratory difficulty,
recovering spontaneous ventilation, and a safe transfer to the post-anesthetic recovery unit (PACU).
Discussion: algorithms recommend an extubation strategy as a logical extension of the intubation process,
preventing haemodynamic and cardiovascular reflex responses, presence of difficult airway at initial airway
management, or delayed recovery after the surgical intervention.
In a non-systematic review regarding extubation management, using databases, Google Scholar and expert
opinions, the incidence of extubation failure varies between 6 and 47%, with an overall increase in the
duration of mechanical ventilation, increased mortality, a greater need for tracheostomy, and higher medical
costs (2). In NAP4, serious complications during extubation following anesthesia occurred in 13% of cases
and a 5% mortality was evidenced (3).
We used TT VLM as SAD to allow a viable and safety extubation strategy with continuous visualisation and
uninterrupted ventilation, controlling gradual awakening, achieving to remove it once the patient is seen to
be ventilating correctly.
References:
1. Hurtado EM, Merchante MS. Safe Extubation with Totaltrack® Video Laryngeal Mask. Acad. Anesthesiol.
Int. 2016;1(1):3-5.
2. Metzner J. et al. Closed claims’analysis. Best Pract Res Clin Anaesthesiol 2011;25:263–76.
3. Cook TM. et al. Fourth National Audit Project. Major complications of airway management in the UK. Part
1: anaesthesia. Br J Anaesth. 2011 May;106(5):617-31.
Learning points:
- Extubation is an elective procedure and must be a well-planned, controlled, gradual and "reversible"
process, ensuring the minimum interruption in the administration of oxygen.

10 / A case series of Safe Extubation with Totaltrack® VLM (Video Laryngeal Mask) and literature review