Evaluation of Arterial Blood Gas as a predictor of successful tracheal extubation of patients undergoing high risk elective gynaecological surgery

Extubation in high risk surgeries involves many factors including ventilation, oxygenation, hemodynamics, fluid status and blood loss. Extubation carries a risk of reintubation. A comprehensive tool is needed to assess these factors and Arterial Blood Gas i.e ABG is one such tool. Extubation criteria used in OT focusses on subjective measures like head raising, following commands and verbal response which can be unreliable. ABG offers a more objective assessment, potentially improving extubation decisions in high risk surgeries. While ABG analysis is widely used to make extubation decisions in ICU settings, there is limited data on their use in OT settings. Patients planned for high risk elective gynaecological surgery will be recruited in the study according to inclusion and exclusion criteria after taking written informed consent. Patient will be taken to OT, general anaesthesia will be given and airway will be secured by an appropriate size cuffed endotracheal tube and standard anaesthesia protocol will be followed. Intraoperative hemodynamic parameters will be monitored and ABGs will be done as per patient requirement. ABG taken just before extubation will be analysed in the study for parameters like PaO2, PaCO2, pH and Bicarbonate levels. Following fulfillment of standard extubation criteria according to departmental anaesthesia protocol, patient will be extubated and followed up for 24 hours post operatively to look for any reintubation. Those not meeting extubation criteria and sent to ICU will also be observed for 24 hours. ABG values will be compared between patients who are successfully extubated in OT with those reintubated within 24 hours postoperatively.