I do some things differently. I give no premedication. Use same induction with nitous oxide and sevoflurane. Place cannula after induction with a nurse holding the mask. I use pethidine for analgesia 1 - 2 mg /Kg and atracurium 0.3 - 0.5mg /Kg, turn off the nitrous oxide and ventilate with oxygen and sevo just before intubation.
I extubate immediately the operation is finished thus avoiding emergence laryngeal spasm. The surgeon always applies suction and haemostasis so I don't suck out any more unless necessary thus avoiding overstimulation. I give reversal drugs just before extubation then sit at the top of the table ventilating the lungs with oxygen thus maintaining good oxygenation and getting rid of sevoflurane.
I transfer to the trolley after patient is breathing well.
Usually not too many problems. One case only of clot in the trachea - quite worrying at the time as it caused complete obstruction. Reintubated and it came out when I re-extubated.
I extubate immediately the operation is finished thus avoiding emergence laryngeal spasm. The surgeon always applies suction and haemostasis so I don't suck out any more unless necessary thus avoiding overstimulation. I give reversal drugs just before extubation then sit at the top of the table ventilating the lungs with oxygen thus maintaining good oxygenation and getting rid of sevoflurane.
I transfer to the trolley after patient is breathing well.
Usually not too many problems. One case only of clot in the trachea - quite worrying at the time as it caused complete obstruction. Reintubated and it came out when I re-extubated.