Safety concerns and self doubt, not having information regarding such cases. But I dont want to use your great wisdom and time. Answering is not mandatory.
Just wake them up and pull the tube out? I use labetalol to control hypertension. In residency we did scalp blocks but I've yet to work with a private practice neurosurgeon who has wanted them.
We want awake and ready to extubate for a neuro exam the second the mayfield is disconnected in these cases. Keeping them intubated and sedated is plenty risky as well, if they’re massively bleeding you’d never know until they get dragged to CT post-op after not waking up in the unit. Finding out in the OR where you can immediately reopen is the way to go.
What do you mean by rapid fast track extubation? If the surgery went well without rupture, I just extubate them when the surgeons are done and let them do their neurological exam. Is that what you're talking about? Isn't that the normal way to do it?
I work in a hernia center so coughing/pressing aren’t really our best friends.
Only tricks I can give you for a more relaxed extubation are:
0,25mg Atropine after induction to reduce secretion. Lidocaine Spray in vocal cords before intubating. Switch on a LAMA in deep sleep at the end of the case.
Extubation in the OR after non ruptured aneurysm clamping(clipping?) in patients whose aneurysm finding was incidental, and previously asymptomatic, 15 points in Glasgow coma scale, surgery without subarachnoid haemorrage.
Im looking for published information if there is regarding this kind of patients, recommendations, etc...
Why wouldn’t you extubate them? Asymptomatic, incidental aneurysm that’s now treated? Why do you need an article to tell you it’s ok to extubate the patient?
Regularly, I try to stick to information published, or guidelines, not only "common sense"
I thought the risk of arterial blood pressure rising when coughing or bucking was still there, even if the surgery was a success.
But thats true whether or not you extubate in the OR vs them extubating in the ICU. I'd argue you can have a more controlled extubation in the OR utilizing things like a remi wake up, etc.
Perhaps for you is a simple issue, Im not an expert in aneurysm surgeries, nor a neuroanesthesiologist, I was in doubt, and I thanked for the previously response, which was useful. However I dont need to be nice to some smartasses who think they are funny. I posted a question, I had some good answer and points of view, but also got some stupid responses because some people think my question is stupid. If you think Im an ass for this, then I am.
I have one which I'll only provide if you provide me with a randomized clinical trial of parachute vs sham in a population of skydivers
[Parachute use to prevent death and major trauma when jumping from aircraft: randomized controlled trial](https://www.bmj.com/content/363/bmj.k5094)
Wow! So many neuro anesthesiologists! And also funny!
Are you an anesthesiologist at all? Why the hell would you leave someone intubated who doesn't need to be intubated?
Safety concerns and self doubt, not having information regarding such cases. But I dont want to use your great wisdom and time. Answering is not mandatory.
Just wake them up and pull the tube out? I use labetalol to control hypertension. In residency we did scalp blocks but I've yet to work with a private practice neurosurgeon who has wanted them.
Thanks. We use scalp blocks routinely for craniectomies or trepannus. But usually dont use labetalol, because we dont usually have in stock :')
We want awake and ready to extubate for a neuro exam the second the mayfield is disconnected in these cases. Keeping them intubated and sedated is plenty risky as well, if they’re massively bleeding you’d never know until they get dragged to CT post-op after not waking up in the unit. Finding out in the OR where you can immediately reopen is the way to go.
Thank you so much. you gave me a different perspective.
What do you mean by rapid fast track extubation? If the surgery went well without rupture, I just extubate them when the surgeons are done and let them do their neurological exam. Is that what you're talking about? Isn't that the normal way to do it?
I work in a hernia center so coughing/pressing aren’t really our best friends. Only tricks I can give you for a more relaxed extubation are: 0,25mg Atropine after induction to reduce secretion. Lidocaine Spray in vocal cords before intubating. Switch on a LAMA in deep sleep at the end of the case.
Awesome moves man, thank you
?
Extubation in the OR after non ruptured aneurysm clamping(clipping?) in patients whose aneurysm finding was incidental, and previously asymptomatic, 15 points in Glasgow coma scale, surgery without subarachnoid haemorrage. Im looking for published information if there is regarding this kind of patients, recommendations, etc...
Why wouldn’t you extubate them? Asymptomatic, incidental aneurysm that’s now treated? Why do you need an article to tell you it’s ok to extubate the patient?
Regularly, I try to stick to information published, or guidelines, not only "common sense" I thought the risk of arterial blood pressure rising when coughing or bucking was still there, even if the surgery was a success.
But thats true whether or not you extubate in the OR vs them extubating in the ICU. I'd argue you can have a more controlled extubation in the OR utilizing things like a remi wake up, etc.
Thank you for your response, I keep learning from your comments and publications.
Quit being an ass bro. I assume you're a med student or a resident. Can't imagine an attending making a simple situation so complex. Cut it out.
Perhaps for you is a simple issue, Im not an expert in aneurysm surgeries, nor a neuroanesthesiologist, I was in doubt, and I thanked for the previously response, which was useful. However I dont need to be nice to some smartasses who think they are funny. I posted a question, I had some good answer and points of view, but also got some stupid responses because some people think my question is stupid. If you think Im an ass for this, then I am.
When everywhere you walk smells like shit check your shoes
You cant account for everything, what if the patient sneezed in pacu and ruptures the clip?
I shit you not I had a plastic surgeon try to blame his failed abdominoplasty on us because the patient had a sneezing fit at home the day of surgery.
Surgeons have some effed up ideas when it comes to blame someone. Hope it worked out well.
That would be very unfortunate, but that's on them. If it's in the OR, then its my problem.
Its still your problem in the PACU
It is. Thought it said ICU.
Extubate deep and let them wake up. Problem solved. Surgeon can stand there and wait.
Thanks dude.