I started off my day today doing a hip on patient that was a know difficult intubation (had the letter and everything).

We give him some prop, able to mask with two hands and oral airway (patient had a crazy beard), 80mg sux - glidscope. Perfect grade I view, ETT in.

Surgeon turns to me, " I want no twitches, the whole case."

No problem, 30mg of roc in with 0.8 of hydromorphone.

After prep: MD makes the incision. BP's up. I give some fent and some prop and creep up on my agent. Next pressure, BP still up. Check my twithes too - 4/4, BP 130(s). Surgeon looks over, "What is going on! John you are killing me with that BP!"

I crank up the agent and check the IV site. Yup, infiltrated. The guy had great veins so I quickly started a second line. Patient still had 4/4 twichtes. I give some more roc.

The patient does well for the case (about 2hrs long). At the end he has 4/4 of twitches.. But, after talking to the MDA we decide to take him out intubated and wait another 30minutes and then reverse. The concern being that that the 30mg of roc in the infiltrates site could leach out.

Would you guys have extubated in the OR?