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Background: Early extubation after cardiac surgery is associated with decreased hospital stay and resource savings with similar mortality and has led to the widespread use of early extubation protocols. In the Vascular Quality Initiative, there is significant regional variation in the frequency of extubation in the operating room (endovascular aneurysm repair [EVAR], 77%-97%; open repair, 30%-70%) after repair of intact abdominal aortic aneurysms (AAAs). However, the effects of extubation practices on patient outcomes after repair of AAAs are unclear., Methods: All patients undergoing repair of an intact AAA in the Vascular Study Group of New England from 2003 to 2015 were evaluated. Patients undergoing concomitant procedures or conversions were excluded. Timing of extubation was stratified for EVAR (operating room, <12 hours, >12 hours) and open repair (operating room, <12 hours, 12-24 hours, >24 hours). Prolonged hospital stay was defined as >2 days after EVAR and >7 days after open repair. Univariate and multivariable analyses were completed, and independent predictors of extubation outside of the operating room were identified., Results: There were 5774 patients evaluated (EVAR, 4453; open repair, 1321). After both EVAR and open repair, respiratory complications, prolonged hospital stay, and discharge to a skilled nursing facility (SNF) increased with intubation time. After adjustment, the odds of complications increased with each 12-hour delay in extubation: respiratory (EVAR: odds ratio [OR], 4.3 [95% confidence interval (CI), 3.0-6.1]; open repair: OR, 1.8 [95% CI, 1.5-2.2]), prolonged hospital stay (EVAR: OR, 2.7 [95% CI, 2.0-3.8]; open repair: OR, 1.3 [95% CI, 1.1-1.4]), and discharge to SNF (EVAR: OR, 2.0 [95% CI, 1.5-2.8]; open repair: OR, 1.4 [95% CI, 1.1-1.6]). Predictors of extubation outside of the operating room after EVAR included increasing age (OR, 1.5; 95% CI, 1.2-1.8), congestive heart failure (OR, 1.9; 95% CI, 1.2-3.0), chronic obstructive pulmonary disease (OR, 2.0; 95% CI, 1.4-2.9), symptomatic aneurysm (OR, 3.8; 95% CI, 2.3-5.7), and increasing diameter (OR, 1.01; 95% CI, 1.01-1.01). After open repair, increasing age (OR, 1.4; 95% CI, 1.1-1.6), congestive heart failure (OR, 1.8; 95% CI, 1.01-3.3), dialysis (OR, 2.8; 95% CI, 1.7-70), symptomatic aneurysm (OR, 2.8; 95% CI, 1.9-4.3), and hospital practice patterns (OR, 1.01; 95% CI, 1.01-1.01) were predictive of extubation outside of the operating room., Conclusions: The benefits of early extubation in cardiac patients are also seen after AAA repair. Suitable patients should be extubated in the operating room to decrease respiratory complications, length of stay, and discharge to an SNF. Early extubation protocols should be considered to reduce regional variation in extubation practices and to improve patient outcomes., (Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)

Capnography measures carbon dioxide concentration or partial pressure of the respiratory gas continuously and non-invasively. The endtidal value is of great diagnostic value, it corresponds approximately to the arterial value, except for ventilation-perfusion-mismatching (horse), shunting (horse), or increased dead-space-ventilation (panting in the dog). Capnography primarily serves for monitoring of spontaneous and artificial ventilation, it is a reliable method for detecting hypo- and hyperventilation. Because metabolism and circulation influence the amount of carbon dioxide eliminated in the lung, capnography monitors these functions too. The plotting of the carbon dioxide concentration as a carbon dioxide-time-diagram draws attention to malfunctions of the equipment. Technical problems of capnography depend on the design of the capnograph (main- or side-stream) used as well as on the weight of the patient. In the discussion the value of pulse oximetry and capnography in detection of critical events during anaesthesia is compared. Capnography is superior to pulse oximetry in the capability to detect critical events. But pulse oximetry complements capnography perfectly, both methods together give a good impression of the patient's state of health.

Two non-invasive continuous techniques for monitoring the respiratory function during anaesthesia have been established during the last year: pulse oximetry for monitoring the adequate oxygen supply and capnography for measuring the carbon dioxide elimination. In human medicine both are accepted as essential monitors with great reliability. Whether clinical use and interpretation can be transferred to animals without any restrictions will be discussed by looking on the physical and engineering background as well as the physiologic interpretation of the measured variable and their capability to detect critical events during administration of anaesthesia. Part I: Pulse oximetry measures the arterial oxygen saturation continuously and non-invasively. Its application in veterinary medicine must be discussed critically concerning the method as well as the interpretation. The information obtained is very different during injectable and inhalant anaesthesia. Respiratory depression is easy to detect while the animal breathes room air spontaneously. Is the inspired air enriched with oxygen, like during inhalant anaesthesia, normal values of oxygen saturation can mask the respiratory insufficiency and may give a false sense of security.