[Verse 1] The volatile's dialed down, the surgery is closing, Nitrous off, the patient's slowly surfacing and showing, Reversal timing matters — don't jump the gun too fast, Neostigmine needs a twitch count, four-of-four to last, Sugammadex wraps the rocuronium tight, Cyclodextrin chemistry, it pulls it from the site, Check the TOF ratio, point-nine or above, Residual block will steal the airway that you love [Chorus] Wake up smooth, not bucking on the tube, Deep or awake — you've got to choose, Reflexes back, tidal volume in range, Laryngospasm's the ghost that haunts the stage, D-R-U-G-S, M-E-T, N-E-U-R-O — delayed emergence, you need to know, Hypothermia, residual block, check the whole row [Verse 2] Awake extubation — you want the patient biting, Following commands, eyes open, cough igniting, Sustained head lift, five seconds minimum cleared, Oxygen saturation, end-tidal CO2 reared, Deep extubation works for the laryngospasm-prone, Asthmatic airways, pediatric patients on their own, But you need a patent airway and a steady hand, Guaranteed mask ventilation — that's the contraband plan [Chorus] Wake up smooth, not bucking on the tube, Deep or awake — you've got to choose, Reflexes back, tidal volume in range, Laryngospasm's the ghost that haunts the stage, D-R-U-G-S, M-E-T, N-E-U-R-O — delayed emergence, you need to know, Hypothermia, residual block, check the whole row [Verse 3] Laryngospasm hits — the cords slam shut like vault doors, Positive pressure first, jaw thrust the mandible toward yours, Succinylcholine point-one to point-two per kilo, Breaks the spasm open, gives the oxygen somewhere to go, Negative pressure pulmonary edema follows in the wake, Frothy pink sputum flooding alveoli in its earthquake, Treat it with CPAP, diuresis if severe, Watch the oxygen, it clears within a day or near [Bridge] Delayed emergence — the differential's wide, Benzodiazepines linger, opioids hide, Flumazenil, naloxone, but use them with care, Rebound sedation sneaking back when you're not there, Hypothermia steals the metabolism slow, Warm the patient, watch the temperature before you go, Hyponatremia, hypoglycemia, stroke — Neurologic causes aren't just anesthetic smoke, Emergence delirium — the pediatric wild card, Sevoflurane inhalation hits the hardest and the hardest scarred, Dexmedetomidine soothes it, fentanyl trims the edge, Propofol in small doses walks you back from off the ledge [Chorus] Wake up smooth, not bucking on the tube, Deep or awake — you've got to choose, Reflexes back, tidal volume in range, Laryngospasm's the ghost that haunts the stage, D-R-U-G-S, M-E-T, N-E-U-R-O — delayed emergence, you need to know, Hypothermia, residual block, check the whole row [Outro] Lidocaine on the tube before the volatile clears, Dexmedetomidine infusion quiets emergence fears, Timing the reversal, watching every single sign, Smooth extubation — that's the clinical bottom line
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