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Bucking, LITA tube and APCU extubation   Message List  
Reply | Forward Message #4386 of 5821 |
Re: [ai] Bucking, LITA tube and APCU extubation

Paul, we all respect your extensive experience and yes, you say my personal preference is to extubate in the OR...

Extubation practices can influence how the whole operating room runs. Then - especially if you are in private practice perhaps you want to know if it is safe enough So if one can argue Recovery Room extubation is safe enough then in routine cases it should be the way to go, with exceptions as needed.   

Ivan Hronek MD


On Jul 2, 2009, at 5:55 AM, Paul Kempen <kmpnpm@...> wrote:


The LITA tube is an expensive way to perform the "Kempen technique" of lidocaine installation via any  existing ETT. That LITA ETT has an injection port just above the cuff, and you must have one of these expensive tubes in place to do the lidocaine injection. My technique uses only ANY Standard ETT as the mode of injection (see last post).
I have heard the statement: " I have never regretted NOT extubating a patient, but have regretted an extubation". I personally do not agree with this as some signficant pertubations can be caused by an in situ ETT. Also, although we take great care in trying to "minimize hemodynamic pertubations at intubation" the area regarding minimizing hemodynamic and respiratory pertubations at EXTUBATION is often deemed a "fact of life" or otherwise acceptable consequence of avoiding laryngospasm by waiting till awake.  I routinely assess the airway during induction for the purpose of eliminating the ETT as soon as practical. LIdocaine will obliterate the stimulus, which can become the cause of reflex=laryngospasm! Traveling down the hallway to a distant PACU with an ETT or even LMA can lead to significant hemodynamic and ventlatory pertubations in an unanesthetized airway. Hence my personal preference to extubate as soon as possible in the OR and observe to
assure airway patency in the spontaniously ventilating patient-some jaw thrust can be required! At the same time if agent is eliminated early and after the ETT tracheal tissues have been anesthetized, you can typically go to very minimal level of anesthesia (i.e. N2O alone) or emerge the patient to "open your eyes and stick out your toung" to then pull  the ETT without any pertubation. The great thing is the ability to assess the numbness vie "the cuff Test" while the ETT is still in and airway assurred!
Gotta try it to appreciate it. The key is hjaving a good 3 liter of gass pass up through the cords while actively bagging at a pressure of 20-30 minimum to carry the slowly injected 5 cc of 2% lidocaine up from the tip of the ETT toward the tounge!

P Kempen
Cleveland




Fri Jul 3, 2009 4:12 am

ivanhronek
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Message #4386 of 5821 |
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The LITA tube is an expensive way to perform the "Kempen technique" of lidocaine installation via any  existing ETT. That LITA ETT has an injection port just...
Paul Kempen
kmpnpm
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Jul 2, 2009
12:56 pm

Your post very deep as usual but a little complex as you tend to talk about more than issues at the same time. As to OR extubation: jaw thrust or similar...
Ivan Hronek
ivanhronek
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Jul 2, 2009
5:45 pm

Paul, we all respect your extensive experience and yes, you say my personal preference is to extubate in the OR... Extubation practices can influence how the...
Ivan Hronek
ivanhronek
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Jul 3, 2009
4:52 am

Our practice of extubation in the OR vs recovery room is largely dictated by the culture of the institution. The recovery room nurses at my institution are...
James DuCanto
jducanto
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Jul 3, 2009
10:00 am

So you have enough ventilators in the PACU to cover virtually all of your beds? We extubate in the OR unless the pt is going to stay ventilated, and seldom...
Miller, Sanford
sanfordmmiller
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Jul 3, 2009
2:12 pm

You can do that - these don't have to be sophisticated ventilators but usually you can get most patients breathing spontaneously towards the end of the case...
Ivan Hronek
ivanhronek
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Jul 3, 2009
5:13 pm

Somehow this thread has become very complicated over a very routine subject. Except for the sick patient who has been in surgery all day, or similar patient,...
Joseph Lesser
jlessercrna
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Jul 3, 2009
10:05 pm

Joe, if you were an OR manager, and if you critically look at the time it takes from the end of surgery to leaving the OR, in a large OR suite you will get to...
Ivan Hronek
ivanhronek
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Jul 3, 2009
10:20 pm

Ivan, I've just never worked anywhere that the anesthesia staff could not have the patient extubated and breathing spontaneously by the end of the case,...
Joseph Lesser
jlessercrna
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Jul 3, 2009
11:06 pm

Get an RT specifically assigned to the PACU? Buy enough ventilators to supply the PACU if most pts come in intubated? In the midst of a hiring/purchasing...
Miller, Sanford
sanfordmmiller
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Jul 4, 2009
8:44 pm

Sandy, this is your beloved scepticisim again...You know I have always been your great supporter, but I have to say scepicism is easy - you don't have to do...
Ivan Hronek
ivanhronek
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Jul 4, 2009
10:29 pm

Ivan, I love the way you love my skepticism, but you seem to have forgotten how Bellevue works-or, since you were a resident, you may never have known. Trying...
Miller, Sanford
sanfordmmiller
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Jul 6, 2009
11:43 am
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