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Recovery – General Anesthesia

by Brian Warriner, MD
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    00:00 Reversing muscle relaxation. We talked about reversing muscle relaxation in a previous lecture.

    00:05 But as an overview of anesthesia in general and maintenance of anesthesia, and leading up to recover, remember to give narcotic analgesics during surgery so that the patient is comfortable when they awaken. And many of us give a little extra right at the end of surgery so that, as the patient's waking up, they'll have a minimum of pain. Monitor muscle relaxation through surgery and reverse usually, because it's not expensive with an anticholinesterase inhibitor such as Neostigmine.

    00:35 The dose of Neostigmine it's about 0.5 milligram/kg and you have to add in an anti-muscarinic, such as Glycopyrrolate 0.4 milligram. Reduce or turn off the vapour, but continue to ventilate the patient until the patient begins to make ventilatory efforts on his self, by himself or by herself. And let them take control of the ventilation as they continue to recover. So, initially you're bagging them or letting the ventilator control their ventilation. But as they begin to make more effort on their own, you back off a little bit on the bagging and then ultimately, they should be able to control ventilation on their own.

    01:17 Extubate the patient when the patient is awake and responding to your voice. So, I always talk to the patients as they're waking up, we usually call their name. And if they open their eyes and I ask them if they're having pain, or you know, whatever, and they respond appropriately, I'll extubate.

    01:35 So you deflate the cuff and you pull the tube out. But don't extubate too soon or patient may become apneic and require manual ventilation, and laryngoscope may occur, which is spasm in the muscles in the larynx, which can make ventilation very difficult. Remember that often, the only reason the patient's breathing at the end of surgery, is because they got the tube in place and it's irritating them. As soon as you take that tube away, they have no reason to breathe anymore. So you have to make sure they're actually responding before you take away the tube. Place an oxygen mask on the patient. Move to a stretcher and transport the patient to the post-anesthesia care unit or PACU. Maintain verbal contact with the patient


    About the Lecture

    The lecture Recovery – General Anesthesia by Brian Warriner, MD is from the course Anesthesia.


    Author of lecture Recovery – General Anesthesia

     Brian Warriner, MD

    Brian Warriner, MD


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