Favorite MAC tricks?

[propadope]

I thought we decided that it was due to laryngeal closure

Can be both. I have seen VC closure several times and chest wall rigidity a few times

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[dhb]

I thought we decided that it was due to laryngeal closure

One of the most elegant study i've seen.

 

[Arch Guillotti]

Usually chase the remi with 25-50mg of ephedrine

 

[Hork Bajir]

I’ve seen some people give as much as 8mcg/kg of remi for an RSI (in the days before sugammadex). Intubating conditions were excellent, approximated sux. Gave 30mg of ephedrine as a chaser, train track vitals. FWIW

 

[pgg]

It's not real

Whether it's "chest wall rigidity" (it isn't) or vocal cord closure (it is) the effect on mask ventilation is the same and the treatment is the same, so there's not much point splitting hairs.

 

[propadope]

Whether it's "chest wall rigidity" (it isn't) or vocal cord closure (it is) the effect on mask ventilation is the same and the treatment is the same, so there's not much point splitting hairs.

But if the tube is in and you can’t ventilate because the compliance is 0 then its definitely chest wall rigidity. Ive seen it and it was immediately relieved with sux. It wasn’t an obstruction or in the goose

 

[dhb]

Whether it's "chest wall rigidity" (it isn't) or vocal cord closure (it is) the effect on mask ventilation is the same and the treatment is the same, so there's not much point splitting hairs.

I don't deny that the effect is the same but i wouldn't say that differenciating between 2 totally different concepts is splitting hairs. Invoking "Chest wall rigity" screams "i haven't spent 5min to think about the physiological concept of what i'm saying".

 

[Velefunt]

I remember reading that a nasal trumpet will alleviate hiccups from propofol during mac cases.

Because I read it here and then looked up the lit, I've tucked this one under my belt for those situations where it's appropriate. I've done it twice I think.

 

[Velefunt]

When the preop nurse puts in the IV and its taped like a pile of @#$% with the catheter halfway out and they go "its positional" and of course the case is TIVA.

Edit: This was supposed to go in the pet peeves thread lol.

I think I've mentioned before that there's an inverse relationship to how elaborate the dressing is, to how well the IV will flow (or is strictly ornamental).

 

[fakin' the funk]

My favorite MAC trick is telling the surgeon that they are really asking for GA and then performing it and charting it appropriately as GA

Deity level s&it here

 

[coffeebythelake]

But if the tube is in and you can’t ventilate because the compliance is 0 then its definitely chest wall rigidity. Ive seen it and it was immediately relieved with sux. It wasn’t an obstruction or in the goose

So you routinely intubate without muscle relaxant?

 

[Arch Guillotti]

But if the tube is in and you can’t ventilate because the compliance is 0 then its definitely chest wall rigidity. Ive seen it and it was immediately relieved with sux. It wasn’t an obstruction or in the goose

Not convinced.

 

[propadope]

So you routinely intubate without muscle relaxant?

Used to before covid.

 

[propadope]

Not convinced.

Not sure what else it could be. Patient was not light either. All I can say is that VC closure is much more common and Ive had to give sux quite a few times for that.

 

[dhb]

Not sure what else it could be

Bronchospasm

 

[propadope]

Bronchospasm

Relieved with sux?