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ORX Awards and the Winners Are ... - September 2014 - Subscribe to Outpatient Surgery Magazine

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

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9 2 O U T P AT I E N T S U R G E R Y M A G A Z I N E O N L I N E | S E P T E M B E R 2 0 1 4 light" with an SGA in. Usually it's the young strapping lad who bends the normally straight SGA tube into a 90-degree angle with his teeth. While this may seem innocuous and he'll let go eventually, the negative inspiratory pressure during his attempts at inspiration against an obstructed tube can result in negative-pressure pulmonary edema. Not something you want to have happen in the elective SGA case. I've seen everything from using multiple tongue blades placed on top of each other to "wedge" open the mouth to a rapid bolus of IV propofol or nar- cotic throwing the patient back into apnea. What works best in my opinion is 10 mg of IV succinylcholine. It works fast and only lasts long enough to push in a few breaths of your volatile anesthetic of choice to get the patient back to a safe anesthetic depth before pulling the SGA or continuing the surgery. Lube where the tube meets the mask of the SGA. To effectively place an SGA, you have to use some lube for placement. But don't place gobs of lube on the back of the mask and tip of the SGA. Not only does this do little to help with placement, but it can be a risk for partial laryngospasm. The portion of the SGA that needs the most lube during placement is the portion of the tube just distal to the mask. This portion sees the most friction going in against the palate. Placing a small amount of lube where the tube meets the mask will ease insertion and avoid any unintentional partial laryn- gospasms. Doing a bronchoscopy case? Use an SGA. Bronchoscopy cases can be challenging. There have been 2 prevailing ways to do these cases: straight sedation and with an endo- 7 8 D I F F I C U L T A I R W A Y S

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