it's june again...

[hypnosisdoc]

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what comes with a bunch of new PGY-2 surgical residents is unpredictable (at least for now) procedure time. just had two cases in OR today, a lap chole took 3hrs to finish, and an infusaport under GA went on forever and more than 40mins to suture 2 2" incisions.

while moving along my residency, i've learnt to turn of flurans and leave patient on nitrous, and propofol bolus as needed to keep patient spontaneous at the end of the case. it works fine when the case time, especially closing time is predictable.

with unpredicated closure time and unfamiliar faces on the other side of curtain, what do you senior guys do to keep patient spontaneous, yet guarantee the patient not moving at the end if you don't know how long it will take them to finish suturing...

in regards to NDMR, what agent do u prefer and how do you dose and time your NDMR during this kind of situation without delaying waking-up time?

thanks for your input,

 

[Noyac]

what comes with a bunch of new PGY-2 surgical residents is unpredictable (at least for now) procedure time. just had two cases in OR today, a lap chole took 3hrs to finish, and an infusaport under GA went on forever and more than 40mins to suture 2 2" incisions.

while moving along my residency, i've learnt to turn of flurans and leave patient on nitrous, and propofol bolus as needed to keep patient spontaneous at the end of the case. it works fine when the case time, especially closing time is predictable.

with unpredicated closure time and unfamiliar faces on the other side of curtain, what do you senior guys do to keep patient spontaneous, yet guarantee the patient not moving at the end if you don't know how long it will take them to finish suturing...

in regards to NDMR, what agent do u prefer and how do you dose and time your NDMR during this kind of situation without delaying waking-up time?

thanks for your input,

If you mis-time the case length then you get burned because you can't wake the pt up at the end. However, if you get them breathing spontaneously you can keep them asleep for as long as you need. Then at the end of the case pull the tube and put an oral airway in or leave the LMA in if thats what you used. Take them to the PACU breathing spontaneously and by the time you have given report, they will be coming around. And quite comfortable I might add.