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It may not be important from your point of view but it is from the point of view of the administration, the surgeons and also many anesthesia providers: if you can get through the lineup quick, everyone will be happier. Don't forget, you may be more efficient than others, but it's the average of all that counts.
I myself am not slow but I would be lying if I said I can get every single patient out of the OR in 5 minutes, like i would if I took the patients to the recovery room with their airway.
Just count all the minutes it will take you in a week. That doesn;t only hold you back but al those dependent on you - patients, surgeons and nurses. The OR extubation system is the more common way of doing it - like you say - but that by itself doesn't necessarily mean it is better. Sorry to be so complicted...
Ivan Hronek MD
Los Angeles, CA
http://health.groups.yahoo.com/group/Anesthideas/
Do not fear to be eccentric in opinion, for every opinion now
accepted was once eccentric. Bertrand Russell
From: Joseph Lesser <kycrna@...>
To: Anesthideas@yahoogroups.com
Sent: Friday, July 3, 2009 3:03:53 PM
Subject: Re: [ai] Bucking, LITA tube and APCU extubation
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, don't most of you wake your patient up and extubate them in the OR before leaving for the PACU? This is the norm for us, even in a busy university setting where we only get the sick that everyone else turfs to us.
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 which then becomes the 'challenge' for us to achieve. Like Jim says, it's all just what you get people used to doing - then they consider that normal. If you get a respiratory tech assigned to PACU with a sufficient amount of circuits and explain the advantages of such an arrangement everyone understands - the administration, the surgeons and the anesthesiologists will all be happier as they get more done in a shorter period of time and the OR becomes more like an efficient surgicenter - look at the smoothness and low level of frustration in those in comparison with regular ORs.
Ivan Hronek MDSo 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 have more than 2 or 3 vents going at once. Getting any more is a major hassle.
Sanford M. Miller, MD
sanford.miller@nyumc.org
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From: Anesthideas@ yahoogroups. com [mailto:Anesthideas@ yahoogroups. com] On Behalf Of James DuCanto
Sent: Friday, July 03, 2009 5:56 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 all ICU trained, so they don't flinch when a patient arrives that needs a ventilator or a t-piece.
Jim
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