Cleviprex

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
pgg said:
Neat thing about electronic records is they keep people honest ...
Click to expand...
Doesn't matter, as long as nobody actually looks at them. It should be a measure of professionalism, especially for CRNAs.

Obviously, there are some brittle, difficult to manage, patients but, when most of the charts look like the one above, it speaks volumes.
Members don't see this ad.
 
Hell, I don't even like using remi in CEA's cuz I end up giving more pressors during the case. I'm not saying it's wrong or bad, just my style. But it can make that crna's record look better.
 
Noyac said:
But it can make that crna's record look better.
Click to expand...
Doubtful. Look at the sevoflurane values for that case ... this was a person trying to titrate minute-to-minute BP variations with the volatile gas dial.

1.7 to 0.7 to 1.4 to 1.8 to 1.4 to 2.9 to 2.1 to 0.7 to 0.5

It's like watching one of those high school videos about drunk driving with the guy swerving around the parking lot knocking over cones and overcorrecting, always behind, always slow to react.

Then, two hours into the case, he switches to isoflurane. Just ... wow.

This person has a fundamental misunderstanding of how anesthesia works. Give him some remifentanil and he'd just try to titrate that up and down q3 minutes too.
 
  • Like
Reactions: 2 users
Members don't see this ad :)
That place needs some new surgeons if a carotid is going over 2 hrs. Geesh.

The only time anti hypertensives come into play in a carotid is on emergence when they just opened up a high grade stenosis and you're concerned with reperfusion injury.
 
Things sure have become complicated with open AAA repair and carotids. Routine infusions to keep the pressure down? A bolus and infusion of an epidural for AAA repair and labetalol for most CEA's work pretty well. Then, patients around here probably aren't as "brittle" as other places.
 
vector2 said:
Seriously? Half our carotids are old brittle hypertensives who come in day of surgery SBP 160++. Usually need cardene around incision and emergence/PACU, neo for induction and middle part of the procedure.

OCD infusion titration and bolusing of cardene and neo is how I get my CEAs to look like this
37NrBg3.jpg



and not this (CRNA)
roxt9gd.jpg
Click to expand...

So, your surgeons don't shunt?
 
pgg said:
Doubtful. Look at the sevoflurane values for that case ... this was a person trying to titrate minute-to-minute BP variations with the volatile gas dial.

1.7 to 0.7 to 1.4 to 1.8 to 1.4 to 2.9 to 2.1 to 0.7 to 0.5

It's like watching one of those high school videos about drunk driving with the guy swerving around the parking lot knocking over cones and overcorrecting, always behind, always slow to react.

Then, two hours into the case, he switches to isoflurane. Just ... wow.

This person has a fundamental misunderstanding of how anesthesia works. Give him some remifentanil and he'd just try to titrate that up and down q3 minutes too.
Click to expand...
But they are our equal, dammit!!!!!
 
sevoflurane said:
Yeah... seems a bit odd to load up a vasodilator for a CEA case where you actually want to keep them w/in 20% of their baseline and then go up on that when cross clamped.
I honestly can't remember the last CEA I had a vasoodilator infusion going.
But people do things differently.
Click to expand...

I guess it depends on your definition of "loading up". I usually just bolus 50-100mcg cardene and turn up the remi for incision, but I think having a cardene infusion running around closure, extubation, and into the PACU is the way to go. I chart snipe a fair amount and I can guarantee you that it's not just my institution where the pt's MAP is through the roof when the tube is coming out. Sure, you can push a little labetalol before you roll out of the room and hope for the best once the patient is reaching PACU discharge criteria, but I think have a titratable order cardene infusion in the PACU has been the way to go for our patient population as far as keeping MAPs in the desired range, and for keeping the nurses and surgeons happy (i.e. not calling you every 10 min because their BP is out of parameter).

Most of our surgeons use shunts. And most of them are crusty old guys with FACS after their name.
 
vector2 said:
I guess it depends on your definition of "loading up". I usually just bolus 50-100mcg cardene and turn up the remi for incision, but I think having a cardene infusion running around closure, extubation, and into the PACU is the way to go. I chart snipe a fair amount and I can guarantee you that it's not just my institution where the pt's MAP is through the roof when the tube is coming out. Sure, you can push a little labetalol before you roll out of the room and hope for the best once the patient is reaching PACU discharge criteria, but I think have a titratable order cardene infusion in the PACU has been the way to go for our patient population as far as keeping MAPs in the desired range, and for keeping the nurses and surgeons happy (i.e. not calling you every 10 min because their BP is out of parameter).

Most of our surgeons use shunts. And most of them are crusty old guys with FACS after their name.
Click to expand...

All good Vector. Just different than the way I do mine.

For the young padawans out there, is hypotension a common problem after CEA? Why?
 
You must log in or register to reply here.
Next unread thread
Top