1. General Anesthesia Maintenance, Emergence, and Extubation
Lauren Hojdila, MSA, AA-C
Nova Southeastern University

2. You are creating an individual anesthesia experience.

3. Steps for Maintenance with: Sux at Induction
Check for reversal of sux-induced muscle paralysis with nerve stimulator
Dose NDMR for level of surgical blockade as required
Give medications as indicated by the patient’s vital signs
Narcotics
Muscle relaxants
Inhalational agent (adjust concentrations)

5. Steps for Maintenance with: Roc at Induction
Check for level of muscle paralysis with nerve stimulator
Dose additional NDMR for level of surgical blockade as required
Give medications as indicated by the patient’s vital signs
Narcotics
Muscle relaxants
Inhalational agent (adjust concentrations)

6. Steps for Emergence
Monitor the neuromuscular blockade with nerve stimulator
When you have at least one twitch you can reverse the muscle relaxant with a combo of:
Neostigmine
Glycopyrrolate
•Gradually decrease inhalational agent
Goal is no agent at the end when extubating the patient
Increase patient’s EtCO2 to stimulate the patient to spontaneously ventilate when reversed
Titrate narcotics to respirations
Suction patient – Suction Saves Lives!!

7. Steps for Emergence
When patient is able to follow commands and meets the requirement of extubation
Deflate cuff of ETT
Squeeze anesthesia bag to give a breath as you pull the ETT from the patient
Place mask back on the patient to ensure that they are able to spontaneously ventilate adequately
Look for chest rise, +vapor and +ETCO2 & adequate tidal volume
Transfer patient to PACU with O2:
via nasal cannula, face tent, face mask as indicated

8. Nerve Stimulator

9. Nerve Stimulator Handheld machine to “test” recovery of paralysis
Best location for placement to monitor block of vocal cords is orbicularis occuli
•Best location for monitor of skeletal muscle block is adductor pollicus

10. Nerve Stimulator Choices
•Tetanus vs TOF (train of four)