Case: Bilateral total knee revision

[bcat85]

Just put her to sleep. She has normal biventricular function. I wouldn't mess with her pacemaker (its all lower extremity), give her the standard dose of prednisone, and do it. I'd rather do 1 4 hour operation than two 2-hour operations. You could get away with some sort of complex spinal (maybe), but why? The biggest immediate postop issue you could run into is respiratory failure from her COPD, but the likelihood of that occurring in lower extremity surgery is quite low.

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[Arch Guillotti]

I think you can eke out 5 hours with spinal if you do iso bupi 15 mg, epi wash and 100 of duramorph.

Try tetracaine.

 

[cchoukal]

Try tetracaine.

Used to use that for primary joints in residency.

 

[deleted162650]

I think you can eke out 5 hours with spinal if you do iso bupi 15 mg, epi wash and 100 of duramorph.

You can get there with just 15mg of bup. I get 3hrs from 7.5mg iso bup (no epi no narc).