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A certain CRNA on this forum is claiming that he can "guarantee" no awareness to all his patients.
Let's hear some opinions on that.
Let's hear some opinions on that.
A certain CRNA on this forum is claiming that he can "guarantee" no awareness to all his patients.
Let's hear some opinions on that.
Awareness is only a problem if you use muscle relaxants. So if your patient is not paralysed if he becomes aware he'll hit you or the surgeon and make his displeasure known.
A certain CRNA on this forum is claiming that he can "guarantee" no awareness to all his patients.
Let's hear some opinions on that.
You still don't get it do you?So some of your patients wake up during surgery?
The day my patients experience awareness when I guaranteed them they wouldnt, then you can call BS. But I feel pretty damn comfortable with the 1 in 14500 chance. Especially when the procedure is not trauma, emergency OB, or cardiac. Since I do no trauma or cardiac the odds are even less.
You still don't get it do you?
The point is: If something could happen you can't "Guarantee" it won't.
In medicine you don't guarantee anything, period.
Let me give you an example:
Let's say you have a curable disease, let's say Gonorrhea.
So, you go to the doctor, he gives you antibiotics, can he guarantee that you will be cured?
The answer is obviously: NO
Because although unlikely, you can still develop Gonococcal Arthritis or even Septicemia and die.
So the Doctor can be reassuring and comforting but he can not guarantee anything.
Think about it.
You still don't get it do you?
The point is: If something could happen you can't "Guarantee" it won't.
In medicine you don't guarantee anything, period.
Let me give you an example:
Let's say you have a curable disease, let's say Gonorrhea.
So, you go to the doctor, he gives you antibiotics, can he guarantee that you will be cured?
The answer is obviously: NO
Because although unlikely, you can still develop Gonococcal Arthritis or even Septicemia and die.
So the Doctor can be reassuring and comforting but he can not guarantee anything.
Think about it.
"
The point is bagillions of people undergoing surgery have recall. IT ISN'T A BIG DEAL!!!! Our field screws up in not pointing this out, as well as not implementing rare awareness as a rare normal side effect of prefectly good general anesthesia. People can't sue you for MH. It's an accepted rare complication. Awareness should be considered the same (though that doesn't free you from awareness due to YOUR fault, such as an empty vaporizer).
And if the patient wants to become a lifelong screwup because awareness supposedly ruined her life, have her speak to thousands of fully awared people that had regional anesthesia, and tell her to get a life.
Our field screws up in not pointing this out, as well as not implementing rare awareness as a rare normal side effect of prefectly good general anesthesia.
I agree that awareness should be an accepted rare complication, because that's what it is.Plankton, do you agree with the statement made below? Do you think that awareness should be an "accepted rare complication"? Do you think that it "isnt a big deal"?
So some of your patients wake up during surgery?
The day my patients experience awareness when I guaranteed them they wouldnt, then you can call BS. But I feel pretty damn comfortable with the 1 in 14500 chance. Especially when the procedure is not trauma, emergency OB, or cardiac. Since I do no trauma or cardiac the odds are even less.
Haven't you been watching the news? The last guy who guaranteed something wound up in court! He won the case, but I guarantee you he doesn't have that sign up in his business anymore.
i always belived that if i was in the one mac range of a gas with no paralytic i was damn shure that there was no way anyone could remeber it. i did a knee scope with an lma in the last year where the sevo was 2.2% soon after induction and the pt did not move and vitals did not change but when i got a page a week later and had to go to preop clinic to meet this guy he told me he remebered most everything, never had any pain, but remebered what we were talking about and was able to tell me verbatum, he was not mad or upset but wanted to ask me what he could do in the future to never have this happen again. so note to self there is never an absolute in this feild and most times it is vodo majic.blaz
Which case you are talking about?
quote]
I mean the guy who "guaranteed" satisfaction at his dry cleaning business. he lost a guy's pants and got taken to court. You can read about it here:
http://abcnews.go.com/TheLaw/story?id=3119381
Basically, if you guarantee something and then the opposite happens, people are going to be disgruntled. But if you're straight with them and say that it's low risk but still possible, and then you have a bad outcome, at least you have given full diclosure.
You are going to compare gonorrhea to awareness?
Nobody is comparing the two in the way you are talking about. They are not even related for your information since you seem to think they are being compared. The statement is refering to a "guarantee" of an outcome. Don't be a **** stirrer. Discuss the topic intelligently or go back to your area.
I know Noy. And yes, I know I am taking a risk at the Guarantee when I do...which I dont do for everyone. But sometimes I am willing. I just depends on the day and the patient. Obviously there is a chance...But if I run the anesthetic the way I usually do with a BIS, the likelihood is very very slim.
My point of that post to to address the importance of awareness. Someone stated it "isnt a big deal". I disagreed. And thankfully, so did Plankton. It truly surprises me that any anesthesiologists thinks that it isnt.
Do you use the BIS for every case?
The only cases I really use it in are the elderly that I want to run much less than 1 MAC on, occasional traumas, and spines under TIVA. Its another expense put on our system that isn't necessary all the time IMHO.
Is mac awake .5 MAC?
Is mac awake 0.25 MAC?
I feel that if you run someone at a 1/2 mac your pretty much covered for amnesia. Plus there is always the 1mg or 2 of versed I give up front.
Do you use the BIS for every case?
The only cases I really use it in are the elderly that I want to run much less than 1 MAC on, occasional traumas, and spines under TIVA. Its another expense put on our system that isn't necessary all the time IMHO.
"""Howver, on your 80 year old with mild dementia 0.25 MAC is MORE than sufficient. If your goal is MINIMAL vapor you should use BIS and other agents like midazolam, low dose ketamine, low dose propofol etc.""""
Blade... and others...
what's the highest BIS you would tolerate in a person to run the lowest vapor?
Generally, 60's.
I would tolerate higher if I was having difficulty keeping them alive.
I've said this b/4 but it was some time back. I did an extraction of retained products in the OR after a delivery with some versed and ketamine a while back. The pt was not intubated (don't critisize its not the topic right now) but was sedated to the point of unresponsive. I slapped a BIS on her and it read 94. After the procedure she did not remember a thing. The BIS never dipped below 90. Ketamine will do this.
Do you use the BIS for every case?
The only cases I really use it in are the elderly that I want to run much less than 1 MAC on, occasional traumas, and spines under TIVA. Its another expense put on our system that isn't necessary all the time IMHO.
BIS has not been proven to do anything - it's a device in search of an indication.Lotsa ball-swinging around here, and plenty of anecdotal evidence.
also, who thinks you cant get awareness if no NMB is on board? thats ridiculous. you may not have a problem with movement, but wait until you get that phone call a week later from the guy who heard everything (but maybe didnt move because they felt no pain, etc.).
BTW, the BIS costs $16 and the B-AWARE study quantified cost to prevent one legitimate case of awareness at $2200. (admittedly thats in australia) Id take that any day of the week and twice on Sundays. Also, an 04 report had it at a cost of $5.55 per patient when you factor in decreased drug usage and potential efficiency.
Im still on the fence somewhat about the BIS, but it has been shown to decrease incidence of awareness and it has been shown to improve efficiency.
BIS has not been proven to do anything - it's a device in search of an indication.
OK- at $16 each to prevent one "one legitimate case of awareness at $2200" ? That's one case of awareness for every 138 cases. GIMME A BREAK!
You must be reading Aspect's literature. Common sense and the realities of actual practice has to come in somewhere. Just like Sebel's "landmark" study - the incidence of awareness is 1:1000. BS!!!! A total crock!