By using rocuronium and its reversal agents sugammadex, lidocaine, [sz]-2 agonist, epinephrine, sevoflurane, hydrocortisone, magnesium sulfate, and deep extubation, we were able to intubate smoothly and extubate
successfully after the surgery without intensive care.
Muscle strength and endurance testing results were not utilised to influence the decision to extubate
Some anaesthetists prefer to extubate
at a deeper plane to prevent laryngospasm.
Nasogastric probe was placed for feeding and decided not to extubate
for edema in airway to pass.
consultant anaesthesiologist Dr Rajesh Garg who is known to extubate
patients immediately after surgery took the lead in anaesthesia accompanied by clinical perfusionist Monsy Sam and Abdul Ahad.
Due to chronic, multiple respiratory failure and inability to extubate
and transition to noninvasive ventilation, she underwent tracheostomy for long-term invasive ventilation at 13 months of age.
The patient had a tracheostomy preformed due to lack of improvement of the lingual edema and the inability to extubate
. The severity of her macroglossia proved too severe for manual reduction and a several-day trial of bite blocks, similar to that described by Foreman et al., proved unsuccessful.
The patient receiving the double lung transplant may be easier to extubate
as the anticipated uniformity of "new" lung units will be easier to ventilate and subsequently wean from mechanical ventilation.
Wean off as tolerated after 48 based on CVS evaluation * Switch to BIPAP and then extubate
* If tolerated, switch to oral medicines after extubation * Prior to extubation, dexamethasone 0.5 mg/kg/dose CVS * Place CVL (preferable IJV, SCV) + arterial line * Follow mixed VO2 Q 12 h * Add L-carnitine 100 mg/kg/day for 6 weeks * ECHO: Monitor cardiac functions daily * Pro-BNP: If good marker for monitoring of cardiac dysfunction Monitor frequently for end organ perfusion (urine output, acidosis, skin condition, body temperature, CNS status) * Can use digoxin 5 [micro]g/kg/dose if only persistent tachycardia (age-speci-c heart rate), urine output > 1 mg/kg/h and serum potassium > 3.5 mmol.
This "ABCDE Bundle", includes Awakening and Breathing trial coordination to assess daily ability to extubate
, Careful sedation choice, Delirium monitoring and Early progressive mobility.
However, there has been a drive in my employing trust to allow the recovery practitioners to extubate
in recovery, without the anaesthetist present.
The seven steps are: talk with the family, ensure orders are written, prepare drugs, extubate
or not, what about the monitor, ensure readiness, and proceed.