Intraoperative Management
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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.
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For superficial procedures → consider local anesthesia or peripheral nerve blocks, with or without moderate sedation.
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If possible use Spinal/Epidural over GA
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If moderate sedation is used → ventilation should be continuously monitored by capnography or another automated method
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Consider administering CPAP or using an oral appliance during sedation to patients previously treated with these modalities
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General anesthesia with a secure airway is preferable to deep sedation without a secure airway, particularly for procedures that may mechanically compromise the airway.
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Extubation:
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Awake if possible
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Full reversal
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Carried out in the lateral, semiupright, or other nonsupine positions.
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Adapted from:
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American Society of Anesthesia Guidelines 2014: Anesthesiology. 2014 Feb;120(2):268-86.
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The Canadian Anesthesia Society Guidelines 2010: Can J Anaesth. 2010 Sep;57(9):849-64