Coughing during MAC
I have had an unusual string of cases recently where I am running a simple MAC case on propofol and about an hour or so into the case, the patient will begin aggressively coughing, likely from secretions accumulating in their oropharynx.
Am I just not deep enough? Do you routinely give everyone glyco for MAC? What am I doing wrong? (Source: Student Doctor Network)
Source: Student Doctor Network - January 11, 2018 Category: Universities & Medical Training Authors: codeb1ue Source Type: forums
Barbiturates amnesia?
Obviously barbiturates are rarely used now a days since the introduction of safer sedatives/ anesthetics, but I know they still are used for certain things especially in neurology such as refractory seizures or wada tests.
When used, do they cause anterograde amnesia like other GABA acting sedatives/ hypnotics like benzos or propofol? (Source: Student Doctor Network)
Source: Student Doctor Network - December 6, 2017 Category: Universities & Medical Training Authors: Healthinfo104 Source Type: forums
DHCA and barbiturates
What does your institution use for cerebral protection during DHCA? I'm mainly interested in any barbiturate that you give or not give. What about propofol? How do you dose it? (Source: Student Doctor Network)
Source: Student Doctor Network - December 6, 2017 Category: Universities & Medical Training Authors: DrN2O Source Type: forums
Weird Response to Propofol
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Source: Student Doctor Network - October 22, 2017 Category: Universities & Medical Training Authors: AngelofHysteria Source Type: forums
MBB duration
To make long story short:
56 year old with axial LBP worse in AM, will standing and with extension. MRI with diffuse "severe disc degeneration. Has bilateral L3 to sacrum MBB with 0.5% bupivacaine and has > 80% relief for what he describes as a day. Confirmatory block done with 2% lidocaine and reports no relief. Of note, due to insurance limitations procedure done in hospital. Anesthesiologist snows patient with propofol and when I go to examine him he is out cold. As it happens he is...
MBB duration (Source: Student Doctor Network)
Source: Student Doctor Network - August 17, 2017 Category: Universities & Medical Training Authors: NJPAIN Source Type: forums
Routine Prone LMA Insertion
I am a troglodyte, learning anesthesiology during the Pleistocene epoch. During a locums assignment recently, I came upon what I believe is a curious practice at a surgery center. Patients for prone surgery are routinely placed in that position on the OR table, then are given 200mg propofol plus 100mg lidocaine after which have an LMA placed (by CRNAs). The reason for this appears to be self serving by the surgery center staff in order to save their backs from having to roll patients into...
Routine Prone LMA Insertion (Source: Student Doctor Network)
Source: Student Doctor Network - August 2, 2017 Category: Universities & Medical Training Authors: algosdoc Source Type: forums
Hypotension
New CA1 here had a case the other day that still has me wondering what happened.
56 yo male, history of HTN and B-cell lymphoma comes in for a neck dissection/lymph node biopsy.
Patient was induced uneventfully with 120mg propofol, 50 of fentanyl and succinylcholine. No BP issues at this point.
Placed a cobra ETT and the plan was to keep the patient on the deeper side as the surgeon doesn't want the patient paralyzed.
I get the patient to 1.1 MAC and give 50 of fentynl just before...
Hypotension (Source: Student Doctor Network)
Source: Student Doctor Network - August 1, 2017 Category: Universities & Medical Training Authors: NOsaintsfan Source Type: forums
Anesthesia at a new facility, what to watch out
A new surgery center is wanting me to give sedation for MAC cases for podiatry. These are the things that I Checked out.
Iv start kits
Medications, versed, fent,propofol, epi, glycopyrollate, cagluconate, that are available. Succinylcholine not available.
Anesthesia machine, monitors Oxygen tank available, no pipeline oxygen
Ambubag available.
Worried about laryngospasm. I know laryngospasm has been dealt with at length here. Ability to positive pressure ventilation.
Worried about...
Anesthesia at a new facility, what to watch out (Source: Student Doctor Network)
Source: Student Doctor Network - June 23, 2017 Category: Universities & Medical Training Authors: inquisitiveanes Source Type: forums
Circ arrest
for my fellow cardiac peeps, anybody have any tricks they like to do before/after circ arrest? (Propofol burst suppression, antioxidants, etc.) (Source: Student Doctor Network)
Source: Student Doctor Network - June 12, 2017 Category: Universities & Medical Training Authors: gasdoc77 Source Type: forums
Office Based Anesthesia (Pediatric Dental)
My group is looking into expanding our practice to include office based anesthesia. Mostly the impetus for this is that the pediatric dentists in the area have expressed concern that the provider currently providing "sedation" in the office may not be well suited to their needs. I wanted to get input from those who have set up such a practice and how they have set things up.
I think we would be likely to nasally intubate most patients and run a propofol TIVA. I know others include Remi,...
Office Based Anesthesia (Pediatric Dental) (Source: Student Doctor Network)
Source: Student Doctor Network - May 17, 2017 Category: Universities & Medical Training Authors: WDP05 Source Type: forums
Is Gi sedation with Anesthesia coming to an end?
In conclusion, PHAX may have potential to match propofol in performance as a fast-onset, short-acting IV anesthetic but with less cardiovascular depression, airway obstruction, and pain on injection. (Source: Student Doctor Network)
Source: Student Doctor Network - January 1, 2017 Category: Universities & Medical Training Authors: BLADEMDA Source Type: forums
Anesthesiologist identified in Joan Rivers GI death
http://pagesix.com/2015/01/04/anesthesiologist-in-rivers-fatal-throat-exam-identified/
She may be F'd
300mg of propofol? But she tried to say computer double counted 120mg of propofol?
If I were her and she's knows she's F'd. I'd settled. Throw the center under the bus by being too cheap and not carrying Sux becAuse they are for profit and didn't want to spend $3000/year on MH cart.
Also throw GI docs under the bus by doing illegal kickbacks with company model OIG opinion...
Anesthesiologist identified in Joan Rivers GI death (Source: Student Doctor Network)
Source: Student Doctor Network - November 12, 2016 Category: Universities & Medical Training Authors: aneftp Source Type: forums
how to titrate iv anest drug in acute patient who needs emergent intubation? time to peak effect?
hi,friends..i often told to always do titration when we want to give a hypnotic drug to an acute patient...it makes sense because they usually need less of it..right? i am curious though..how would you approach that?
i was told to always wait for the time to peak effect(ex. propofol: 2-3 mnts) before giving another large dose..what do you think about it? any input or thoughts are welcome..sincerely,Ketap (Source: Student Doctor Network)
Source: Student Doctor Network - May 12, 2016 Category: Universities & Medical Training Authors: ketap Source Type: forums
Propofol infusion at end of case for fast wake up
Has anyone ever heard of this technique? One of my co-residents is trying this out, and I saw a couple of CRNAs trying this on general cases. I stalked the EMR to see when exactly they deployed and then stopped the propofol infusion but I can't remember now off the top of my head.
What is everyone's thoughts on this? (Source: Student Doctor Network)
Source: Student Doctor Network - April 25, 2016 Category: Universities & Medical Training Authors: CharleyVCU1988 Source Type: forums
esophageal food impaction...tube or not
What are people's practices on adult patients who come in with esophageal food impactions? These patients are never NPO of course. Fortunately I trust the GI docs I work with and do propofol w/o a tube but I always dread these cases and feel like I'm not following standard of care for a patient who isn't appropriately NPO.
When do you decide to intubate? (Source: Student Doctor Network)
Source: Student Doctor Network - March 21, 2016 Category: Universities & Medical Training Authors: Colba55o Source Type: forums
