Propofol induced myoclonus?
Anybody ever seen this? I seem to always get the weird anesthesia reactions that never happen to anyone else.
I was doing moderate sedation on this lady in her 60s, ASA 3, s/p total left shoulder about 1.5 months ago and the orthopod sent her in after doing an XR in the office that showed prosthetic dislocation. I do all my usual pre-sedation assessment, get everything ready, yada yada. All my back up stuff in the room, ortho talks rads into rolling a c-arm down from the OR and we're ready...
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Source: Student Doctor Network - March 7, 2022 Category: Universities & Medical Training Authors: Groove Tags: Emergency Medicine Source Type: forums
Anesthesia for ESI
Has anybody seen the announcement that medicare is no longer reimbursing anesthesia care for pain procedures? Commercial insurances will follow I assume?
In my area, the local pain MDs employ their own CRNAs and every patient gets snowed with propofol. The all receive large out of network anesthesia bill. (Source: Student Doctor Network)
Source: Student Doctor Network - December 10, 2021 Category: Universities & Medical Training Authors: nycitygas Tags: Anesthesiology Source Type: forums
Is intraop monitoring really that necessary with regional anesthesia?
I run into a scenario every now and then where I block a patient, they have a great block, come into the OR for their hand operation and get a propofol infusion essentially to just "pass the time." Their anesthetic is completely stable, boring, and the sedation is seemingly unnecessary.
My question is, with the right pre-screening, counseling of patient pre-operatively, sufficient lag-time for onset of block and safety monitoring, would it really be that unsafe to have the patient be in the...
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Source: Student Doctor Network - December 6, 2021 Category: Universities & Medical Training Authors: ethilo Tags: Anesthesiology Source Type: forums
Operating without CRNA
Hoping for some honest advice here:
For reasons I won't get into, my employer is asking me to perform upcoming phaco cases under "nurse anesthesia" while we look into replacing our CRNA. Employer also owns the ASC and a few of us operate there.
I have serious hesitations about letting the nurses administer fentanyl without a CRNA present. Versed, fine. Propofol, obviously not.
Am I crazy to put my foot down on this? I'm not comfortable with recussitation and my patients are often elderly...
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Source: Student Doctor Network - November 25, 2021 Category: Universities & Medical Training Authors: Catarockin Tags: Ophthalmology: Eye Physicians & Surgeons Source Type: forums
Legal precedent?
In short, middle aged woman gets a scope by GI with propofol sedation. 8 hours later she signs a legal contract which is notarized. 3 years later she’s claiming that the contract is not valid because she had received anesthesia.
The notary (who was also a family friend) testified that they remember her not acting out of the ordinary that day.
Patient also remembers details of the encounter where the contract was signed.
Is there a legal precedent for something like this? (Source: Student Doctor Network)
Source: Student Doctor Network - October 7, 2021 Category: Universities & Medical Training Authors: Propofool123 Tags: Anesthesiology Source Type: forums
Covid sedation thought
I'm old hat and (once upon a time) covered small community ICU's in a day before it required a fellowship.
We know Covid patients do abysmally after intubation.
Curious if anyone is aware of literature to suggest that the choice of sedation may be associated with outcome(s). We are aware of frank Propofol infusion syndrome, but is it possible that subclinical mitochondrial dysfunction related to the soybean oil lipid emulsion could be contributing to the negative outcomes
Conversely, some...
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Source: Student Doctor Network - September 29, 2021 Category: Universities & Medical Training Authors: gasdoc77 Tags: Anesthesiology Source Type: forums
What is your Ketofol regimen?
Does anyone have any good recommendations for ketofol infusion dosing for patients with spinals? There are a fair number of LE surgeries in my practice and a large number of morbidly or even super morbidly obese patients which can be difficult to sedate on propofol necessitating the frequent use of oral airways. (Source: Student Doctor Network)
Source: Student Doctor Network - July 2, 2021 Category: Universities & Medical Training Authors: Outrigger Tags: Anesthesiology Source Type: forums
Most Insane Induction I've Ever Had
Middle aged male for enucleation of prostate. Has non-compaction cardiomyopathy with EF of 15% and an LVAD.
I'm not a cardiac guy so always treat these with kid gloves. Pre-induction art line and 16 g PIV placed in the forearm under ultrasound for vasoactives should I need them.
I've had similar patients crump before just by cracking a vial of propofol across the room, so after hooking up monitors and placing a Sedline I started with 0.5mg midaz and 10 mg prop. Waited thirty seconds...
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Source: Student Doctor Network - June 10, 2021 Category: Universities & Medical Training Authors: shepardsun Tags: Anesthesiology Source Type: forums
TIVA then Hiccups.
Wish I had read this thread a few days ago...
Hiccups with lma
Anyone ever have this? What do you guys do?
forums.studentdoctor.net
But don’t you think this is weird? I was running a TIVA with LMA (Propofol mixed with alfentanil) and about an hour in, the patient starts doing the hiccup thing.
I’ve seen it after placement - never like this though.
tried more Propofol. Didn’t help. Then did sux 20mg. Helped for one minute. Then repeated sux with 40mg. Helped for a...
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Source: Student Doctor Network - March 20, 2021 Category: Universities & Medical Training Authors: epidural man Tags: Anesthesiology Source Type: forums
Fast-tracking and regional anesthesia
Hey folks,
I'm trying to explore whether or not incorporating a block bay into our community hospital would result in more fast-tracking of patients. Ideally, I want to reduce the numbers of GAs so we can bypass PACU more often and send straight to phase 2 by relying on a surgical block and mild propofol sedation. From folks who are regional heavy, I want to get a sense of which kinds of cases could be done under a surgical block and which couldn't, based solely on generalities about...
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Source: Student Doctor Network - February 4, 2021 Category: Universities & Medical Training Authors: ethilo Tags: Anesthesiology Source Type: forums
Nerve Monitoring Cases
What do you guys like to do in outpatient ent where they don't want paralysis due to nerve monitoring? I've had a few cases where I'm running a mac of gas and propofol at like 125. There's no remi and I don't want to give too much opioids that would delay the wakeup but their monitoring machine still beeps and they complain about the patient being light. I've just started adding nitrous but I'm trying to avoid it due to environmental impact and I don't actually think the patient is light. (Source: Student Doctor Network)
Source: Student Doctor Network - November 6, 2020 Category: Universities & Medical Training Authors: GassYous Tags: Anesthesiology Source Type: forums
Skin rash after general anesthesia
Patient in 50 s male for out pat arthroscopy develops rash a few minutes after Lma General anesthesia with Versed and fentanyl premed, propofol, lidocaine, glycopyrollate and cefazolin. Patient has had surgery before and received all of the above meds except lido and glycopyrollate. Cefazolin stopped immediately and epinephrine was administered with diphenhydramine, dexamethasone , famotidine.
ventilation was assisted until patient reverted to spontaneous ventilation. The surgeon...
Skin rash after general anesthesia (Source: Student Doctor Network)
Source: Student Doctor Network - October 31, 2020 Category: Universities & Medical Training Authors: Adductor canal Tags: Anesthesiology Source Type: forums
Breastfeeding & anesthesia
I’m not anesthesia.
I do outpatient procedures. The procedures last 5-7 minutes. Patients either get "light" anesthesia with IV benzo and IV opioid or "deep" sedation with propofol.
Today the nurse ran in and asked anesthesia about the patient who was breastfeeding and if they needed to pump and dump. He said yes for at least 24 hours.
I thought that was "old school" and patients didn’t need to do that anymore as there is no evidence it’s necessary for this kind of anesthesia. I was going...
Breastfeeding & anesthesia (Source: Student Doctor Network)
Source: Student Doctor Network - October 3, 2020 Category: Universities & Medical Training Authors: AMEHigh Tags: Anesthesiology Source Type: forums
Heavy marijuana users
Area I work has very high marijuana use in the community and a portion of these patients I would classify as heavy users ( smoke or vape >3 grams per day), vast majority of users are 0.5-1 g daily.
Among the very heavy users, I had noted a few oddities:
40ish male coming in for ureteroscopy developed severe bronchospasm on pushing propofol, no airway manipulation or moving of patient by surgeon. About 90 kg, received 400 mg. Became rigid and notable myoclonus. Bronchospasm broke with ppv...
Heavy marijuana users (Source: Student Doctor Network)
Source: Student Doctor Network - September 22, 2020 Category: Universities & Medical Training Authors: TheLoneWolf Tags: Anesthesiology Source Type: forums
Remimazolam: Useful or Useless?
A few articles have come out describing the characteristics of remimazolam infusions and it appears to have been approved for use in Japan as a general anesthetic.
Anybody think this will change your practice?
Efficacy and safety of remimazolam versus propofol for general anesthesia: a multicenter, single-blind, randomized, parallel-group, phase IIb/III trial
This trial was conducted to confirm the non-inferiority of remimazolam versus propofol in the induction and maintenance of general anesthesia in surgical patients. Surgical patients ...
Source: Student Doctor Network - July 28, 2020 Category: Universities & Medical Training Authors: Ronin786 Tags: Anesthesiology Source Type: forums
