Clinical Question

[bwt02]

Just wondering what the other SRNAs or CRNAs would do in this situations:

64 y/o male ASA III for a hip debridement. Did the case as a TIVA..RSI with cricoid pressure. (Propofol and Succs) 9mg Vec given after twiches returned. Propofol infusion at 100mcg/kg/min, Fentanyl total of 250 mcg tititrated in,Vecuronium redosed 1.5 hours into case. Morphine 10mg titrated in last 30 min of case. The end of the case finally came. Upon checking TOF the twich response was 2/4 (1st twich stronger than 2nd with no 3rd or 4th). Reversal give of 3mg Neostig + 0.6mg Glycopyrolate. Pt returns to spont. breathing with TV of 3-400, lifting head off table and reaching for tube. TOF 4/4 with Fade on tetany. An additional 1mg Neostig + 0.2 Glyco. given. TOF remains 4/4 however fade remains present. I ask him to squeeze my fingers and he responded by with a weak squeeze. What would you do next?????????? Extubate or resedate the patient and wait untill patient was stronger?

[underdog]

How about checking some labs....could hypocalcemia or hypermagnesemia be contributing to muscle weakness??

[bwt02]

End result of the case was: propofol bolus and a little nitrous for sedation. I waited about 20min untill I had a sustained tetany then extubated. The MDA was pushing for me to extubate and not wait the 20 min, however the CRNA I was with supported my decision to wait. Good learning experiece..

[Pete495]

I think you will make a good crna

[charles-thor]

sounds like a lot of vec after a sux induction for a hip debriedment???

there are, however, many ways to skin the commonly quoted cat...