Smooth ASA II morning: pre-ox 3 min, leak test clean, iso at 1.2% with fentanyl CRI, ETCO2 a steady 38 — and then the pulse ox starts wailing 65% like the sky is falling. Moved the clip from a drooly tongue to the lip and it jumped to 99%; love how the monitor keeps me humble while the protocol keeps the patient rock solid.
Same here — if the tongue’s a slip ’n slide, it screams hypoxic. I keep gauze to dry, then move the probe to the ear pinna or prepuce and tape the lead; if the perfusion index is low or fentanyl’s clamped the vessels, a warm pack or tiny fluid bump usually fixes it. My rule: “dry, warm, and re-site” before trusting the number.
Had the same monitor tantrum with iso 1.2% and a fentanyl CRI — vasoconstriction plus drool makes the clip fib… I rub the ear pinna for 10–15 seconds or tuck a warm gel pack around it before moving the probe, and the pleth/perfusion index perks up and SpO2 goes from ‘65%’ to normal; if it still lags, I glance at that steady ETCO2 38 and swap to a reflectance sensor so everyone keeps breathing easy.
I’ve had the “sky is falling” SpO2 when the OR light hits the sensor — slip a glove finger over the clip and wipe the emitter/receiver and it stops acting like a diva. If it still fusses, I park it on the interdigital web or tail and watch the pleth more than the number, @m_lawson89. Do you ever switch the averaging speed on your monitor?