Reversing muscle relaxation. We talked about
reversing muscle relaxation in a previous lecture.
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.
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.
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.
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 during the transfer process