What does it mean....

Usually just a surgeon trying to blame someone else (read: anesthesia) 'cause they are struggling a little.

DO NOT let them bully you into giving more muscle relaxant!!! Just make some noise behind the screen on the anesthesia cart and wait a couple of minutes and tell them they should be relaxed now. I am on my first rotation and gave some and waitied a while for that twitch to come back for reversal never gonna do that again.

Sometimes a little propofol right then can help.

I just ran into that the other day, the CRNA I was with gave the reversal before the surgeon had completely finished closing and he said he was having difficulty. But she didn't want to give muscle relaxant at all, so we turned up the gas and gave a bolus of propofol. I was wondering why not give some succ since the patient didnt have any of the contraindications, but she reminded me that after nondepolarizer and reversal drugs, succ is potentiated and paralytic time is prolonged and not as predictable. Eventually the surgeon was able to stuff the bowel back in there and we just had to wait a little longer while the patient woke up.

Also just wanted to add that with some back cases, after you have already given an adequate amount of relaxant, and have 0/4 twitches, the surgeon will still complain that it is "tight" and they need more relaxation. In that case, the CRNAs I have been with just say we are giving more relaxant, but usually we dont.

the previous posts are correct - a little propofol or deepening via gases will help IF the patient is truly not paralyzed - but remember a 2/4 TOF is sufficient relaxation for any surgical procedure - i have surgeons all the time say - are there any twitches - ... again - as a previous poster stated - sometimes they are just having a hard time and want to blame it on something.

What does it mean when the surgeon complains of a patient being "tight" while they are closing (during a colon resection)? Does he just mean there is not enough muscle relaxant on board? Any thoughts appreciated!!!

Yes, that's what he meant. As the previous posts so articulately stated, the ongoing question "is the patient relaxed enough?" is similar to the rhetorical question, "which came first the chicken or the egg?" By that I mean, a patient with some muscle relaxation on board (and loss of some twitches on TOF) is as relaxed as the surgeon who is operating on him. In my limited, humble experiences it seems as though the experienced, comfortable surgeons are as relaxed as their patients and don't have a hard time. The same can be said for those who are uptight and having difficulty closing.

Z