I had to use an LMA once.

Was doing CEA under cervical plexus block and some sedation, when patient started to obstruct, get hypoxic and confused. I managed to slip him a little propofol, and insert an LMA under the drapes without disturbing the surgical field. 60 seconds later, surgery back under way, and my surgeon amazed that I could intubate so quickly and without having to re-prep and re-drape.  8)

Quote from: Therese Huntly on December 08, 2004, 10:17:33 AM
Incidentally, the patients voice got better after three days.

The fact that his voice returned to normal confirms it was not a surgical error, and that the intubation was the probably cause.

I too intubate children without relaxant, and the trick seems to be to be slick. You get one shot at it, and if you get it in, it is smooth sailing. If you miss first go, the cords respond, spasm and the next passage of the tube will be tighter and potentially more traumatic.

Jason P

After about 30 minutes of hyper or hypo ventilation, the cerebral vessels tend to lose their responsiveness and drift back to their baseline level of dilation. This is why hyperventilation for long periods is no longer recommended for neuro cases and keeping the CO₂ at about 35 is now the objective. For this reason, I find it hard to believe that anyone could get an ischemic CVA from prolonged hyperventilation.