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the SGA tip from flipping back on you.
An SGA is just a bigger and better
oral airway — just leave it there.
It's common practice in anesthesia to pull an SGA while the
patient's still asleep and place an oral airway to help prevent patients
from obstructing in the PACU. However, this just adds an unnecessary
step. An SGA is nothing more than a bigger and better oral airway.
Leave it there and let the PACU nurses (or the patient) pull it out when
they're ready. It's no different than taking out an oral airway on a
patient, but it works better than any oral airway you can place. It takes
a little education with the PACU nurses, but afterward they'll love it. In
addition, you get out of the OR faster so the turnover team can get
started.
Fixing the crowing patient.
A crowing patient gets everyone's attention in the OR. Not
only can it be loud and annoying, but also it's a risk:
Crowing patients are having partial laryngospasms or obstructions.
There are many ways to skin this cat, but the one that works the best
is a combination approach. I give these patients 5-10 mg of IV suc-
cinylcholine, suction the airway through the SGA with a soft suction
catheter and squirt in a few cc's of lidocaine from an LTA kit through
the SGA. Since partial laryngospasms are often the result of secre-
tions on the cords, I also usually give 0.2 mg of glycopyrrolate IV. To
date this has not failed me.
Fixing the patient who chews down on
the SGA, resulting in obstruction.
Everyone has made the mistake of letting a patient get "too
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D I F F I C U L T A I R W A Y S
