J U LY 2 0 1 7 O U T P A T I E N TS U R G E R Y. N E T 4 3
I use a supraglottic airway in
about 80% of my cases. What's
the biggest determinant for when
to use one? I largely base my
decision on the positioning
requirements of the procedure,
and less on the patient's comor-
bidities, which I manage pre-
operatively. For example, I intu-
bate patients placed in the prone
position for a laminectomy and
patients positioned laterally for a
shoulder repair. However, I
might use a supraglottic airway
on an obese, NPO patient having
a knee arthroscopy.
A supraglottic airway is also
not an option for many ENT cases, because it would impede access to the surgi-
cal site. It's also not suited for neck liposuction, because the device's inflated cuff
can slightly deform the neck's anatomy.
3. Reduce opioid use. The side effects of opioids — nausea and vomiting,
itching, sedation — can delay discharge. Regional blocks, take-home pain
pumps and long-acting local anesthetics that surgeons administer at the incision
site at the end of the case are proven pain-control strategies that reduce opioid
use.
I prefer to give short-acting opioids like fentanyl early in the case and
Toradol toward the end of the procedure. I'll typically write post-op orders for
fairly low doses of pain medications, such as Demerol 12.5 mg IV every 5 min-
Patients will give their surgery a thumbs-up
or a thumbs-down based largely on the
actions of the provider at the head of the
table. Besides being the last face they see
before they go to sleep and the first they see
when they wake up, your anesthetists can
influence the answers to these questions:
• Was I nauseated?
• Was I shivering and cold when I woke up?
• Was my throat sore after surgery?
• Was I too sedated from pain medications?
• Did I have a long stay in PACU,
which delayed my return home?
— Michael Reines, MD
THUMBS UP OR THUMBS DOWN?
Anesthesia's Impact
On Patient Satisfaction
