Safer induction for brachycephalics

We’ve had a run of brachy cases this month, and I’m refining our anesthesia protocol to reduce airway risk. Are you pre-oxygenating a full 5 minutes and leaning alfaxalone over propofol for smoother intubation, and do you wait for purposeful swallow before extubation to keep them safest?

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Datamars Compact Max reads 125/134.2 fast; HID to phone forms works, battery lasted our ‘4-hour shift’ in sun.

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@Guide +1; a $25 privacy screen stopped shoulder-surfing in court — matte beats glossy.

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Yes to ‘5 minutes’ if they’ll tolerate the mask; I lean alfaxalone + midaz and do rapid‑sequence with a quick arytenoid lidocaine spray, plus a half‑size smaller tube and suction ready. I don’t wait for a full swallow — extubate at purposeful jaw movement in sternal, then flow‑by O2; micro‑dose dex if they’re thrashy to keep airway tone. @meganS78 have you tried adding a PEEP valve during pre‑ox?

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I switched to a post‑checkout “soft hold” text: Square tentatively books a week window with the care reason (e.g., booster due), auto‑releases in 24h if they don’t tap confirm, and it bumped us to about 80% without clogging 5–7… @samanthaM92 do you auto‑release or keep a couple evening pins?

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Otter.ai’s free tier nails quick depo recaps; great backup, but crosstalk trips it up. https://otter.ai.

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We keep the 5-min O2, but the biggest win has been pre-oxygenating with a PEEP valve (5–8 cm H2O) in sternal and doing a cautious “cuff-up” extubation to pull secretions (think tiny plunger) only if there’s zero resistance. It’s cut our post-extubation snoring/desats a lot; @j_clarkson76, do you have PEEP on your circuits?

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