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Although sevoflurane allows for a rapid awakening, the possibility of<br />
emergence agitation with sevoflurane may adversely affect the post-operative<br />
neurologic exam in a child. What other perioperative intervention may lead to an<br />
undesirable affect on a post-operative neurologic examination?<br />
<br />
a) Use of propofol-based TIVA regimen<br />
<br />
b) Administration of intravenous lidocaine prior to extubation to prevent<br />
coughing<br />
<br />
c) Deep anesthetic extubation while the patient is spontaneously breathing<br />
<br />
d) Use of a balanced anesthetic regimen that includes 50% nitrous oxide<br />
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==Answer==<br />
Answer c. Deep anesthetic endotracheal extubation may be performed when the<br />
patient is spontaneously breathing with either absent or depressed airway<br />
reflexes. This technique can decrease cardiovascular stimulation and reduce the<br />
incidence of coughing with the endotracheal tube. However, an immediate<br />
neurologic examination is usually desired following emergence of anesthesia.<br />
Deep extubation postpones this until the patient is safe to be stimulated without<br />
precipitating laryngospasm, which may be an undesirable length of time.<br />
==Notes==<br />
<references /><br />
:This question originally printed in the [http://www.amazon.com/Justin-L.-Lockman/e/B00FLG5AEE/ref=ntt_dp_epwbk_0 Pediatric Anesthesiology Review Topics] kindle book series, and appears courtesy of Naerthwyn Press, LLC.<br />
==Keywords==<br />
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