Postop precautions for pharyngeal and laryngeotracheal lidocaine

[coffeebythelake]

For awake fiber / lidocaine atomizer / viscous jelly for GI procedures etc. Personally I've found a liking to using 4% LTA for smooth wakeups. I've heard some colleagues instruct pacu not to give anythjng by mouth for at least 2 hours to reduce aapiration risk. What do you do?

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[Gern Blansten]

For awake fiber / lidocaine atomizer / viscous jelly for GI procedures etc. Personally I've found a liking to using 4% LTA for smooth wakeups. I've heard some colleagues instruct pacu not to give anythjng by mouth for at least 2 hours to reduce aapiration risk. What do you do?

I would say it depends on how long the surgery is. If it’s super quick and the patient is in the PACU an hour after administration, maybe it could be an issue. If the surgery is a couple of hours, it’s likely no longer an issue.
If I wanted to be extra cautious, I would have them try small sips of water for twenty or thirty minutes. If they do fine with that, then they are fine and I would advance their diet based on the usual parameters related to their procedure.

 

[Ronin786]

ICU patients routinely progress to full diet after passing a bedside swallow test. Basically just some water and seeing if they choke or start coughing. I can't say I ever ask our PACU what they do, but would hope they're trying clears before handing out the crackers and PB.

 

[woopedazz]

1 hour NBM from the end of surgery or 2 hours from topicalisation. Whichever is later.

 

[MirrorTodd]

This is an excellent QI project for a resident. haha

 

[nimbus]

ICU patients routinely progress to full diet after passing a bedside swallow test. Basically just some water and seeing if they choke or start coughing. I can't say I ever ask our PACU what they do, but would hope they're trying clears before handing out the crackers and PB.

Personal anecdote.

I’ve been dealing with a vocal cord issue. I’m much more likely to aspirate water than crackers with PB. So water is a good test.

 

[Ronin786]

Personal anecdote.

I’ve been dealing with a vocal cord issue. I’m much more likely to aspirate water than crackers with PB. So water is a good test.

These are the dysphagia levels SLP uses.

 

[fakin' the funk]

Would it matter if someone aspirated a sip of ginger ale? No, no it would not. Bombs away.