I was reading threads a while back and I came across a topic dealing with different emergence techniques. I believe it was Toney who described the narcotic wakeup. Well I did it twice last night and let me tell you...it was the best I've ever seen young males wake up. They didn't fight, hardly noticed them going through stage 2, didin't cough. They just opened their eyes, squeezed my hand, I pulled the tube, a little positive pressure, absolutely no laryngospasm!

Basically what I did was get them back breathing early enough to note a good respiratory pattern (tidal volume and RR).

Patient number 1: 22 year old healthy male with fractured zygomatic process. Tidal volume 200's, RR 22. I gave 3 mg of morphine and waited 5 minutes and noted the RR came down to 20, TV 200's. Gave 3 mg MS and wait 5 min. RR down to 17 TV 200's. Gave 4mg MS wait 5 min RR down to 14 TV around 250. Came down on Sevo according to heart rate and blood pressure. RR 14 TV 350. Gave 25 mcg fentanyl, wait 2 min and RR 12 TV 350. By this time they were closing so I kept him at this point, they finished, I put an oral airway in, turned the gas off, suctioned and waited until ET Sevo was 0.3. Gave 100 mg Lidocaine IV and said the patients name, little trap squeeze, he opened his eyes and squeezed my hand and bingo.

Patient number 2 ended exactly the same. I've done some Nitrous wake ups as well and they are nowhere near as effective as narcotic wake up.

Thanks Toney!