Bad breath

[loveumms]

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Has anyone ever noticed how HORRENDOUS patients breath smells after anesthesia? No fail, taking the pt to the pacu … jaw thrusting because the pt weighs 300lbs … pt breathing but, the smell of their breath makes me want to gag.

What is it? Decreased saliva production during the case? Whatever the cause, it’s gross!

 

[jennyboo]

"Raise the head of the bed" and wheel 'em to the PACU in a semi-sitting position... with their face away from you. 😀

 

[Gas]

"Raise the head of the bed" and wheel 'em to the PACU in a semi-sitting position... with their face away from you. 😀

This is exactly what I do - helps them breathe better too.

Most of the time, after emergence/extubation, the CRNA takes them anyway. Yet another thing you don't have to worry about after residency.

 

[coprolalia]

"Raise the head of the bed" and wheel 'em to the PACU in a semi-sitting position... with their face away from you. 😀

You obviously haven't yet done many cases where the neurosurgeons tear the dura. 😉

-copro

 

[Bertelman]

Has anyone ever noticed how HORRENDOUS patients breath smells after anesthesia? No fail, taking the pt to the pacu … jaw thrusting because the pt weighs 300lbs … pt breathing but, the smell of their breath makes me want to gag.

What is it? Decreased saliva production during the case? Whatever the cause, it’s gross!

My guess their breath smelled bad all along, you just didn't have the opportunity to get so close to the source.

 

[Noyac]

I think that it is we are putting things down into the deep recesses of their oral cavities where everyones breath reeks. Even the youngsters who rarely have hallatosis. I pulled an LMA out of a 10 yr old today and thought, " damn her breath stinks for a 10 yr old."

I had surgery not too long ago and I swished with mouth wash b/4 going back b/c I know everyones breath reeks in the OR. Vain and I know it.

 

[militarymd]

I think normally we swallow our spit and kind of clears things in our mouths...keeping the bacteria at bay....

under GA...things become stagnant...and bacteria overgrows....leading to the stink...at least that's my theory.

 

[Noyac]

I think normally we swallow our spit and kind of clears things in our mouths...keeping the bacteria at bay....

under GA...things become stagnant...and bacteria overgrows....leading to the stink...at least that's my theory.

Good theory.

How quickly does the oral floral multiply?

Is it enough in a 30 minute case to create such an odor that was not present pre-op?

 

[militarymd]

Good theory.

How quickly does the oral floral multiply?

Is it enough in a 30 minute case to create such an odor that was not present pre-op?

if you forget your deoderatne....can't you stink it up pretty good in 1/2 hour?

 

[Bertelman]

How quickly does the oral floral multiply?

Is it enough in a 30 minute case to create such an odor that was not present pre-op?

In a lab, I think E. coli splits every 20 minutes, and that's one of the fastest.

Obviously, there shouldn't be E. coli in your pharynx. Nonetheless, even in an hour-long case you'd be lucky to get 2 cell divisions, especially considering the biofilm environment is very different than a plate in a lab.

I think something else is at work here. My guess is that since there is no airflow through the oropharynx, byproducts of bacterial metabolism stagnate, rather than being inhaled and exhaled when awake.

 

[militarymd]

The stink in the mouth is not that of anything living....it smells of DEAD bacteria.

In a lab, I think E. coli splits every 20 minutes, and that's one of the fastest.

Obviously, there shouldn't be E. coli in your pharynx. Nonetheless, even in an hour-long case you'd be lucky to get 2 cell divisions, especially considering the biofilm environment is very different than a plate in a lab.

I think something else is at work here. My guess is that since there is no airflow through the oropharynx, byproducts of bacterial metabolism stagnate, rather than being inhaled and exhaled when awake.

 

[Noyac]

The stink in the mouth is not that of anything living....it smells of DEAD bacteria.

I think colon/bowel stink is worse.

Is it dead?

It's hard to believe anything living can smell that bad.

 

[Arch Guillotti]

leading to the stink...

Nothing worse than the stink.

 

[Noyac]

So, can we give everyone a swish and spit of mouth wash b/4 going back to the OR? Will that make a difference?

 

[Bertelman]

The stink in the mouth is not that of anything living....it smells of DEAD bacteria.

I didn't realize dead bacteria smelled like anything at all. As Noy suggested, the odors from your ass smell worse, and those are most certainly flourishing bacteria.

Here's a plant referred to as a corpse flower. It is quite alive, and emits the odor of rotting flesh when it is blooming, possibly the most "alive" part of its life cycle.

 

[zippy2u]

Back in the day, I used to have a similar problem with the occasional vajayjay; the combination of Irish Spring soap, woodie and Jacuzzi alleviated the problem in most cases. Regards, ---Zip

 

[Noyac]

Back in the day, I used to have a similar problem with the occasional vajayjay; the combination of Irish Spring soap, woodie and Jacuzzi alleviated the problem in most cases. Regards, ---Zip

Umm WHAT?

Are you talking about what I think you are talking about?

I'm starting to think you might be a chic😱

 

[coprolalia]

Back in the day, I used to have a similar problem with the occasional vajayjay; the combination of Irish Spring soap, woodie and Jacuzzi alleviated the problem in most cases. Regards, ---Zip

I think you forgot the bottle of Cristal and the Barry White playing in the background.

-copro

 

[loveumms]

Well, I'm glad others notice it. When I said it to one of my attendings the other day he looked at me like I was crazy.

I do always put up the head of the bed - more for pulmonary mechanics but getting the pts mouth as far as possible is a plus too.

One of the nurses said the funniest things the other day I made that commend to my attending in the OR. Maybe you should invent some mintyflurane. Sounds good to me 😉

 

[Planktonmd]

I think you forgot the bottle of Cristal and the Barry White playing in the background.

-copro

With this kind of problem you need something heavier champagne.