Intubating during surgery?

[wannabesedated]

Hi,

I am hoping someone can answer this question for me. Why would a patient that is undergoing ear surgery (removal of a stirrup) be intubated?

This patient has had nothing to eat/drink prior to surgery

He is diabetic, not sure if that is of importance

Very strong gag reflex (although you can't swallow your tongue, so I doubt that has anything to do with it)

No other major health concerns, 50 y.o male

and Is not under general anesthesia

The tube was placed before surgery..

I am aware that the purpose is to "help the patient breathe", but I was hoping it could be explained why this patient would be at risk for breathing problems/aspiration..

Thanks!

[vamedic4, EMT-P]

Hi,

I am hoping someone can answer this question for me. Why would a patient that is undergoing ear surgery (removal of a stirrup) be intubated?

This patient has had nothing to eat/drink prior to surgery

He is diabetic, not sure if that is of importance

Very strong gag reflex (although you can't swallow your tongue, so I doubt that has anything to do with it)

No other major health concerns, 50 y.o male

and Is not under general anesthesia

The tube was placed before surgery..

I am aware that the purpose is to "help the patient breathe", but I was hoping it could be explained why this patient would be at risk for breathing problems/aspiration..

Thanks!

Hi AshleyDawn...

Intubation is performed to control the airway, that's all. Patients having procedures are given meds to do several things, calm them down, knock them out, et cetera. Intubation allows the anestesiologist complete control of this patient's respiratory status. This way he can ensure that the patient remains adequately oxygenated during the procedure.

Anyone can be at risk for resp. difficulty during a procedure. Even patients who undergo conscious sedation can be at risk for airway compromise. Intubation simply allows us to control the oxygenation status of the patient.

Hope that helps.

vamedic4

It's still raining....ugh.

[CritterLover, BSN, RN]

most patients are intubated during surgery.

[color=#483d8b]

[color=#483d8b]some procedures are the exception, called "monitored anesthesia care" where large doses of sedatives are given (beyond "moderate sedation").these include central venous access procedures done in the or (port a cath, hickman placement), and i'm sure some others that i am not familiar with.

[color=#483d8b]

[color=#483d8b]the type of surgery you are talking about may fall under the scope of "monitored anesthesia care" in some institutions, i'm not sure.

[color=#483d8b]

[color=#483d8b]however, intubation is always the safe bet for managing the airway. may need to intubate the patient, but there is no guess as to whether or no the patient has received adequate oxygenation during the procedure. the intubation virtually guarantees that.

[color=#483d8b]

[color=#483d8b]the patient would be "at risk for breathing problems/aspiration" simply because of the drugs they were given to sedate them.

hi,

i am hoping someone can answer this question for me. why would a patient that is undergoing ear surgery (removal of a stirrup) be intubated?

this patient has had nothing to eat/drink prior to surgery

he is diabetic, not sure if that is of importance

very strong gag reflex (although you can't swallow your tongue, so i doubt that has anything to do with it)

no other major health concerns, 50 y.o male

and is not under general anesthesia

the tube was placed before surgery..

i am aware that the purpose is to "help the patient breathe", but i was hoping it could be explained why this patient would be at risk for breathing problems/aspiration..

thanks!

[heartICU]

Hi,

I am hoping someone can answer this question for me. Why would a patient that is undergoing ear surgery (removal of a stirrup) be intubated?

This patient has had nothing to eat/drink prior to surgery

He is diabetic, not sure if that is of importance

Very strong gag reflex (although you can't swallow your tongue, so I doubt that has anything to do with it)

No other major health concerns, 50 y.o male

and Is not under general anesthesia

The tube was placed before surgery..

I am aware that the purpose is to "help the patient breathe", but I was hoping it could be explained why this patient would be at risk for breathing problems/aspiration..

Thanks!

Just curious - how do you know he was not under general anesthesia? Was this supposed to be done under local anesthesia? Was he provided any sedatives?

Sometimes the meds we give to provide sedation can cause funny things to happen to the airway, like obstruction, etc. Like others said, the safest airway when administering anesthetics (sedatives or otherwise) is one with a cuffed ET tube.

FYI - diabetics do have some degree of delayed gastric emptying, so the fact that he was NPO is nice, but his stomach may not be empty.

[CRNAGAL]

I think I can answer a few questions. I'll start with the airway and positioning. Even though the patient was npo, diabetics are at risk for aspiration due to delayed gastric emptying.

Also, usually during ENT procedures, the table is turned away from the anesthesia provider and you don't have good access to the patient's head, therefore if a sedated pt would become obstructed, you would have difficulty getting in to manage the airway. Plus, it would be interfering with the surgeons ability to work due to the movement during an intricate surgery.

A sedated patient maintaining his own airway may snore. During a surgery such as a hernia repair, no big deal, but when the surgeon is working under the scope, it creates a lot of motion.

The patient also would need to be very still during the surgery and sometimes sedated patients "forget" where they are and move around alot. If a patient is under general anesthesia, you can paralyze them to be sure they won't move during surgery. These are all good reasons for general anesthesia and an ETT.

Another aspect that may come into play is if the patient is a difficult airway. Its much easier and safer to intubate before surgery begins,under controlled circumstances, that have to rescue later.

Its very common for a surgery to be scheduled for a local mac, but ultimately, the anesthesia provider decides the safest course of action. Hope this helps.

[TracyB,RN, RN]

Also wanted to add, that since this is an ear surgery, even though a removal of a stirrup, the ear is a very intricate organ which can easily be damaged by a sudden jolt, or other unplanned movement.

Probably ended up being under general anesthesia because of the being the delicate ear & didn't want to take any unnecessary risks.

If I was having surgery, I'd for sure want to be knocked out before getting a tube down my throat... Awake intubations are horrible!!!!

[passionate]

Did you ask the anesthesia provider of record?

[SFRN]

The post reads as if this patient would be a good candidate for LMA insertion as opposed to intubation. I am just wondering why the patient was intubated as opposed to LMA insertion?

[elcue]

the lma occurred to me too. but with the inherently higher risk of aspiration in diabetics, i imagine most anesthesia providers would choose the ett.

i do a fair bit of ear surgery. it would be just about impossible for an awake, albeit sedated patient to be still enough, long enough, for this delicate procedure.

linda

[GadgetRN71, ASN, RN]

the lma occurred to me too. but with the inherently higher risk of aspiration in diabetics, i imagine most anesthesia providers would choose the ett.

i do a fair bit of ear surgery. it would be just about impossible for an awake, albeit sedated patient to be still enough, long enough, for this delicate procedure.

linda

i agree-the extensive ear surgeries i have seen have had the patient under general anesthesia

.