At the institution where I work as a Nurse Anesthetist, we perform many Thoraco-abdominal aortic aneursym repairs. The paients are in the right lateral decubitus position for 4-6 hours with large volumes of blood products and cystalloid solutions transfused during the case. These patients usually have a significant amount of generalized edema and some laryngeal edema. There are two arguments concerning changing the tube at the end of the procedure. One: Never give up an good airway for a POSSIBLE better one (leave the DL tube in place for 12-24 hours until some of the edema has subsided and then change it). Two: Leaving a large bore DL tube in for an extended period of time will cause necrosis of the vocal cords, and should always be changed out at the end of the procedure.
I would appreciate any input from those of you who routinely do these kinds of procedures as to what your policies are concerning re-intubation after the surgery is finished.
Thank you
James J. Bradley