Airway Obstruction

[yudenisrodriguez]

Hello my fellow pacu nurses! I have an interesting question for you all. I currently work in a ASC for over two years, with whom i had the same Anesthesiologist. When my patients came into pacu from the OR, they were pretty awake but drowsy and 100% breathing on their own with no oral airway in place. Well, we now have a new anesthesiologist for a little over a month and his technique is very different from what I'm used to. The patients come in completely asleep and unresponsive with an oral airway (berman) in place until they wake up. This is fine of course but the problem is almost EVERY patient who comes into pacu has airway obstruction, or ends up with it within a few minutes....which I must respond to by doing a jaw thrust or chin lift, or adjusting their head position for a FEW MINUTES to "de-obstruct" them and get their Sa02 back up... Is this normal? I have other anesthesiologist who have come to our facility before and none of their patients obstruct in pacu.. yes, they are asleep and unresponsive as well - but at least they maintain their airway independently with the oral airway and without me right next to them, watching.. to respond ASAP if needed. yesterday, our last patient of the day came into pacu and obstructed as usual, and I assisted by performing the jaw thrust maneuver and his response was "great! your getting perfect at this!" and i said "well when i have to do this for every patient, i get a lot of practice!" which he then said "well, thats what pacu is for!"

i didn't mean to be rude but i feel like his extubating or ventilation technique before the patient leaves the OR is what is causing this to everyone. is this safe/normal? I understand that patients obviously can obstruct and thats a part of being a pacu nurse but EVERY patient EVERY day?

[toomuchbaloney]

I will only say that if the physician expects that his patients are at increased risk for airway occlusion then the unit management should work that reality into the staffing patterns for patient safety.

[Mavrick, BSN, RN]

Could be he's extubating them 'deep' to prevent bronchospasm and needs to put a nasal airway in place. You still have to staff for that extra 1:1 care. Safe? If you are right at the bedside to provide necessary care. Normal? Apparently for him.

[gizmopacurn]

Sounds like that anesthesiologist has a very different practice than others. I could see every now and then getting a patient who needs airway or jaw thrust but not everyone. He sounds lazy for sure. Sometimes there is a good reason to extubate deep but that is not best practice to just do that for every pt. That would not happen at my facility. I probably get 1 or 2 pt's a day with an oral airway in and maybe 1 or 2 a month that need jaw thrust who are obstructing. Our CRNA's are awesome.