This came up (again) in a recent thread and unfortunately the conversation went down a hill a bit at that point. So, I was hoping for some additional comments here.

Basically, we all have to extubate awake sometimes (challenging airways, full stomachs, etc). My limited experience has lead me to believe that there is an increased risk of laryngospasm in stage II. I think that pulling a tube during this period is risky and does not represent best practice.

So, assuming we all don't want to pull a tube during stage two, what do you use an indicator that it's safe to extubate?

Regular respiratory pattern, spontaneous eye opening, purposeful movement, following commands, end-tidal agent? What tells you it's safe?