Situations when you must go away the tracheal tube in place or delay extubation embody: Airway issues � Patients with potential airway problems corresponding to major maxillofacial surgical procedure or trauma, massive thyroidectomies or other swelling in the airway may typically be left intubated for the primary overnight interval in case there's swelling that might trigger airway obstruction � Decide in advance whether or not to leave the tube in and give a sedative and opiate analgesic so that it is tolerated otherwise the affected person�s coughing or makes an attempt to self-extubate will trigger extra difficulties than intubation solves Haemodynamically unstable patients: very sick patients from haemorrhage or sepsis who: � Do not fully recover � Might want air flow � Suffer cardiovascular collapse in the postoperative interval Hypoxic sufferers who might want ventilation Patients who do not get up as deliberate: � In general, don't extubate an unconscious affected person after surgery or one who reveals no cough reflex when transferring the tube within the trachea � Wait till the affected person is breathing (not breath-holding or biting the tube) and exhibits a gag reflex and, ideally, opens his or her eyes. 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