TYK260

Although sevoflurane allows for a rapid awakening, the possibility of emergence agitation with sevoflurane may adversely affect the post-operative neurologic exam in a child. What other perioperative intervention may lead to an undesirable affect on a post-operative neurologic examination?

a) Use of propofol-based TIVA regimen

b) Administration of intravenous lidocaine prior to extubation to prevent coughing

c) Deep anesthetic extubation while the patient is spontaneously breathing

d) Use of a balanced anesthetic regimen that includes 50% nitrous oxide

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Answer

Answer c. Deep anesthetic endotracheal extubation may be performed when the patient is spontaneously breathing with either absent or depressed airway reflexes. This technique can decrease cardiovascular stimulation and reduce the incidence of coughing with the endotracheal tube. However, an immediate neurologic examination is usually desired following emergence of anesthesia. Deep extubation postpones this until the patient is safe to be stimulated without precipitating laryngospasm, which may be an undesirable length of time.

Notes

This question originally printed in the Pediatric Anesthesiology Review Topics kindle book series, and appears courtesy of Naerthwyn Press, LLC.

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