Intraoperative Management 

 

  • Susceptible to the respiratory depressant & airway effects of sedatives, opioids, & inhaled anesthetics; therefore, the potential for postoperative respiratory compromise should be considered in selecting intraoperative medications. 

  • For superficial procedures → consider local anesthesia or peripheral nerve blocks, with or without moderate sedation.  

  • If possible use Spinal/Epidural over GA  

  • If moderate sedation is used → ventilation should be continuously monitored by capnography or another automated method 

  • Consider administering CPAP or using an oral appliance during sedation to patients previously treated with these modalities

  • General anesthesia with a secure airway is preferable to deep sedation without a secure airway, particularly for procedures that may mechanically compromise the airway.

  • Extubation: 

    • Awake if possible 

    • Full reversal 

    • Carried out in the lateral, semiupright, or other nonsupine positions. 

 

 

Adapted from:

  • American Society of Anesthesia Guidelines 2014:  Anesthesiology. 2014 Feb;120(2):268-86.

  • The Canadian Anesthesia Society Guidelines 2010:  Can J Anaesth. 2010 Sep;57(9):849-64

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