General Anesthesia Maintenance Emergence and Extubation Lauren Hojdila
General Anesthesia Maintenance, Emergence, and Extubation Lauren Hojdila, MSA, AA-C Nova Southeastern University
You are creating an individual anesthesia experience.
Steps for Maintenance with: Sux at Induction § Check for reversal of sux-induced muscle paralysis with nerve stimulator § Dose NDMR for level of surgical blockade as required § Give medications as indicated by the patient’s vital signs – Narcotics – Muscle relaxants – Inhalational agent (adjust concentrations)
Steps for Maintenance with: Roc at Induction § Check for level of muscle paralysis with nerve stimulator § Dose additional NDMR for level of surgical blockade as required § Give medications as indicated by the patient’s vital signs – Narcotics – Muscle relaxants – Inhalational agent (adjust concentrations)
Steps for Emergence § Monitor the neuromuscular blockade with nerve stimulator § When you have at least one twitch you can reverse the muscle relaxant with a combo of: – Neostigmine – Glycopyrrolate § • Gradually decrease inhalational agent – Goal is no agent at the end when extubating the patient § Increase patient’s Et. CO 2 to stimulate the patient to spontaneously ventilate when reversed § Titrate narcotics to respirations § Suction patient – Suction Saves Lives!!
Steps for Emergence § When patient is able to follow commands and meets the requirement of extubation – Deflate cuff of ETT – Squeeze anesthesia bag to give a breath as you pull the ETT from the patient § Place mask back on the patient to ensure that they are able to spontaneously ventilate adequately – Look for chest rise, +vapor and +ETCO 2 & adequate tidal volume § Transfer patient to PACU with O 2: – via nasal cannula, face tent, face mask as indicated
Nerve Stimulator
Nerve Stimulator § Handheld machine to “test” recovery of paralysis § Best location for placement to monitor block of vocal cords is orbicularis occuli § • Best location for monitor of skeletal muscle block is adductor pollicus
Nerve Stimulator Choices § • Tetanus vs TOF (train of four)
- Slides: 10