Originally posted by Diprivan/Vented
We had a morbidly obese pt the other day. Anesthesia nasally intubated him. I don't think I've ever seen anyone attempt it the way they did it. The pt was very lethargic, so the anesthetist began to stick the tube down into his nose. As the pt woke up, the MD simply talked in a soothing tone to the pt. When that didn't work, me and another anesthetist held his arms down with a mod amt of force, but the one inserting the nasal tube kept working it in, using a real soft tone. Finally, he got it, but it was a bit nerve wracking.
What I want to know is why they didn't use any sedation. Is it because they didn't want to knock him out and make a relatively stable situation less stable?
I think every morbidly obese patient should receive awake FIBEROPTIC nasal intubation. Most I have seen have it done with Cocaine applied topically to nares. Smooth as silk. Patients very cooperative and I think feel as if they are enabled to participate in their own care.
Shouldn't every morbidly obese patient undergoing GETA also have full stomach precautions--most importantly, cricoid pressure? Seems like more and more I am seeing people intubate without cricoid in these cases--is there new research out there that says it isn't necessary, or are those doing it this way being needlessly careless?
Now, here's a question: How many still give a corticosteroid (usually IV decadron) for traumatic or prolonged intubations? Seems like we always did it routinely in the '80s and "90s, now I am seeing more people say that the researcch they have read say it makes no difference (although, if the case belongs to an ENT doc, it is still done routinely In fact, some of them have WRITTEN articles espousing the virtues of decadron to reduce laryngeal edema.)
cricoid pressure techniques
Search Tags
Nursing News