challenging cases

Wondering what all those who are practicing, student or professional, consider to be the most challenging cases in anesthesia---ie Backs, heads, hearts, peds, etc.

I know that there are many variables involved and each case no matter how starightforward can turn into a nightmare...but opinions count here....

[smiling_ru]

Lung cases, sick hearts, large cerebral aneurysms, and deep tumors. Dialysis patients and liver failure patients.

Those are my list toppers.

[carcha]

head and neck, and E.N.T., have to be the worst, have never experienced so many problems with laryngospasm and with E.N.T.

[nilepoc]

Carcha, I am not excited to hear this. My first rotation is in ENT. I start it in September. Yahoo. Actually I am looking forward to it, as I feel the extra special airway training will be great for me.

[JasonGreen]

Originally posted by carcha

head and neck, and E.N.T., have to be the worst, have never experienced so many problems with laryngospasm and with E.N.T.

two things come to mind (and I could be way off base)

1. Are you suctioning the mouth enough prior to extubation?

2. Is your scrub tech being loud (banging stuff around) during stage 2?

[yoga crna]

Insurance pays an extra unit for cases where you compete with the surgeons for the airway, Those are difficult cases, then you add blood to the airway and you are asking for a laryngospasm. Those cases are worth the extra money or for you students--experience. Do as many as you can with assistance. You won't be sorry later on in your career.

I work alone in plastic surgey, mostly face and coronal lifts. Yesterday I did an abdominoplasty and it was so great to have control of the airway and tube. On Tuesday, the OR tech pulled out my nasal tube when he was draping for a facelift, and then he fussed at me when I contaminated his field to reintubate the patient. He won't fuss again after I finished with him.

Isn't anesthesia fun!!

YogaCRNA

[gaspassah]

yoga, does this mean you think that the airway in a paralyzed patient is more important than the sterile surgical field?.......just kidding:D

[loisane]

Yoga gives an excellent example of why it takes a great deal of experience to do out-of-hospital practice. As much as I hate to see outsiders (like Liability Insurance providers) dictate our standards of care, I do agree this is no place for new grads. But with increasing experience, even the challenging cases are less intimidating, because you know how to handle the complications that occur.

I think many of us get very comfortable for our typical case load. What could be a very routine case for one person, is very challenging for another.

For me, peds has always been a nail biter, probably always will be. But there are CRNAs who are clinical experts in that environment, and are more challenged by a different type of case.

I have heard some CRNAs say they would rather do a ruptured AAA than a MAC case. But those "general anesthetics with a nasal cannula" are my favorite cases!

Anesthesia is a big, diverse, fun world.

loisane crna

[JasonGreen]

On Tuesday, the OR tech pulled out my nasal tube when he was draping for a facelift,

with the cuff inflated?

[yoga crna]

Yes, Jason the cuff was inflated. The inflated cuff never seems to bother some people. I had one surgeon extubate a patient twice during one face lift by just bouncing the head back and forth. After the second time I put a $500 fine on him. Funny, he never did it again.

Protect that airway.

Yoga

[g8rlimey]

Yoga:

Just wondering what and how this fine you spoke of takes place?

[yoga crna]

Any time someone accidently extubates my patient, due to inattention or carelessness, I tell them they have to pay me $500.00. I didn't charge the OR tech who did it last week, but I can assure you that he won't do it again. The problem was mostly with a young plastic surgeon who bounced the head around without consideration to the airway. If it happens again, I will send him a bill. He knows I am serious about this. Sometimes you just have to treat them like the children they are.

Yoga