Reversal is carried out in the operating theatre or ITU. Ideally, the concentration of inhaled anaesthetic is reduced slowly and all infusions of anaesthetic drugs are ceased and 100% oxygen is given. If present, muscle paralysis is reversed with an anticholinesterase such as neostigmine; this often comes in combination with an anticholinergic drug that reduces its muscarinic side effects - salivation, bradycardia, bronchial secretions. If not, the anticholinergic is given first intravenously.
If the patient was spontaneously ventilating throughout anaesthesia, the anaesthetist simply administers 100% oxygen for a few minutes. This prevents arterial hypoxaemia as nitrous oxide diffuses back out into the alveoli.
Confirmation is made that the patient is spontaneously breathing - ideally, the volume should be measured. If spontaneous ventilation is slow or absent, maintaining high percentage oxygen flow, the stimulus of moving the tracheal tube, or narcotic antagonist may all be considered.
The patient is placed in left lateral position and with suction removal of secretions, the airway is removed. If the patient is stable, they are moved to the recovery room.
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