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General Anesthesia Maintenance, Emergence, and Extubation

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

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General Anesthesia Maintenance, Emergence, and Extubation

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  1. General Anesthesia Maintenance, Emergence, and Extubation Lauren Hojdila, MSA, AA-C Nova Southeastern University

  2. You are creating an individual anesthesia experience.

  3. 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)

  4. 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)

  5. 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 EtCO2 to stimulate the patient to spontaneously ventilate when reversed • Titrate narcotics to respirations • Suction patient – Suction Saves Lives!!

  6. 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 +ETCO2 & adequate tidal volume • Transfer patient to PACU with O2: • via nasal cannula, face tent, face mask as indicated

  7. Nerve Stimulator

  8. 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

  9. Nerve Stimulator Choices • •Tetanus vs TOF (train of four)

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