Deep extubations with Desflurane

[DrBrown]

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Anybody doing deep extubations with Desflurane? After thyroidectomy?

The reason I ask is...I worked with a CRNA on Friday who "loves this technique, because the surgeon is so fast." I have to agree the surgeon is fast-- BUT If you are pulling the tube deep to avoid coughing, just use sevo which is less irritating, put in an ORAL airway and roll to PACU. Any thoughts. BTW I do not mind people going through emergence in the PACU.

 

[Noyac]

Pt's only cough with Des when going down. They don't cough when coming out of anesthesia unless you have done something to make them cough. Des gets a bad rap for this but it usually isn't the DES.

BTW, I do extubate thyroids deep all the time on DES. No coughing.

 

[jwk]

Extubate deep with Des and thyroids all the time, just like Noy.

Oral A/W? My patients with the expensive dental work don't like those. That chin lift / jaw thrust thing I learned in EMT school works great.

 

[dhb]

I agree with previous posters it's not the Des that will cause the coughing

 

[DrBrown]

thanks guys...anybody else? Can you guys quote any studies on this? It seems to me that they do cough a bit more with DES on wake up. Of course, you can cough on sevo, iso, or whatever. Any studies on this specific topic? I know of at least one study in A&A this year for Outpatient surgery comparing sevo and des which showed no difference in D/C from the pacu (Anesth Analg 2009; 109:387-393) AND showed a higher incidence of coughing with DES, so these shorter procedures what are we gaining.

 

[dhb]

I know there is a study showing less coughing with Tiva compared to gases but i haven't seen a comparison between inhalation agents

 

[Planktonmd]

If you are going to extubate deep why do you need to use DES?

 

[dhb]

If you are going to extubate deep why do you need to use DES?

Because if you only have Des or Sevo you have to pick your poison

 

[jwk]

If you are going to extubate deep why do you need to use DES?

Faster wakeups, especially with longer cases and/or obese patients - I know, I know, heresy and BS to some of you Sevo lovers, but I'll take Des over Sevo any day of the week

 

[DrBrown]

I know there is a study showing less coughing with Tiva compared to gases but i haven't seen a comparison between inhalation agents

Anesth Analg 2009; 109:387-393

 

[DrBrown]

If you are going to extubate deep why do you need to use DES?

That is my point also, PLANK. The CRNA in question says it gets her out of the room faster. For me I would just use iso and pull out the tube, and take them to PACU---unless there was a compeling reason not to, of course.

 

[proman]

Does this CRNA also use sevo during the case and switches to des for a faster wake-up?

 

[Noyac]

Faster wakeups, especially with longer cases and/or obese patients - I know, I know, heresy and BS to some of you Sevo lovers, but I'll take Des over Sevo any day of the week

same here.

 

[maceo]

If you are going to extubate deep why do you need to use DES?

they still have to blow it off... and I DO NOT let patients emerge in the pacu.. they emerge in the OR.