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, without any holdup. Your questions therefore, were surprising. Is taking an anesthetised intubated patient to the PACU common in some areas?
Joe
On Jul 3, 2009, at 6:19 PM, Ivan Hronek wrote:
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 several hours in a day.
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...
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From:Joseph Lesser <kycrna@insightbb.com> 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.
Joe
Happy 4th.
On Jul 3, 2009, at 1:12 PM, Ivan Hronek wrote:
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.
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 have more than 2 or 3 vents going at once. Getting any more is a major hassle.
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
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...
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...
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...
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...
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...
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...
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,...
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, 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,...
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...
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, 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...
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