Towards the end of surgery, anesthetic agents are reduced and then discontinued. The residual neuromuscular block is reversed when the operation is finished and, when the patient is able to breathe and protect his airway; the tracheal tube is removed. As with induction, emergence from anesthesia is a time when hemodynamic instability can occur, and the awakening patient may cough on the tracheal tube. Specific medications may be needed to control the blood pressure at this time.
On occasion, immediate extubation is not desirable, for example when there have been serious intraoperative difficulties and the brain is swollen at the end of surgery, or if problems with the airway are anticipated. In such cases a decision may be made to keep the patient sedated and ventilated post-operatively for a period. Decisions of this kind should be made jointly by the anesthesiologist and surgeon. Patients who have had surgery in the posterior fossa or craniocervical region may have inadequate airway protective reflexes post-operatively and should not be extubated until airway reflexes have returned.
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The term vaginitis is one that is applied to any inflammation or infection of the vagina, and there are many different conditions that are categorized together under this ‘broad’ heading, including bacterial vaginosis, trichomoniasis and non-infectious vaginitis.