As a new SRNA, one of the most challenging things is waking people up. It doesn't help that I'm at a teaching institution and the same surgery can vary by up to 45minutes depending on if a med student or a new resident is involved.

As a result, I'm always on the hunt for wake-up trips. So.....the other day a CRNA was telling me about high flow nitrous wakeups. Toward the very end of the case, she cranks on the nitrous at 8L or more (the same flow of O2). The idea being that sevo or iso will come off super fast due to the high flows and the nitrous, plus the patient gets some anesthesia from N20.

What do you think about this technique? Does the N2O actually lead to the volatile off gassing faster (? reverse second gas technique) or is the off gassing the same as if I was using high flow air/O2? Any other caveats about using this method?

Thanks!