Quote from Tranman
, she should be extubate awake..
I don't extubate abdominoplasty patients awake, but actually quite deep. I deflate the cuff slowly, extubate and mask ventilate until awake. The reason--if they buck on the tube they can pop all of their deep muscle abdominal sutures. I had it happen once and you could actually hear the sutures popping. The patient had to be anesthetized again, opened and resutured. Once that happens, you never forget it.
I actually kept her dry fluid-wise. She had totally stable vital signs, urine output of about 35-40 ml/hr, no postural hypotension when put in the semi-sitting lawn chair position or when we turned her lateral to lateral for the thigh and buttocks lift. I gave her 5 liters of warmed crystalloid, which I thought was on the dry side, but had a hard time justifying pushing fluids if she didn't need them. Also, she had 2000 cc of tumescent fluid prior to the liposuction and only 600 cc aspirate.The surgeon asked that I not give hespan, because he has had a bad experience with increased bleeding after hespan use. The plastic surgeons really worry about bleeding. She did well, was awake in PACU with the same vitals as on admission. We will see how she does tonight. She is with our after-care RN, who also is an ICU nurse and who does a great job of taking care of these patients the first post-op night. I'll let you know how she does.
Thanks for the input.