esophageal food impaction...tube or not

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You Don't understand how many Times I'm on call and the attending refuses to use sux. One gen surgeon here does lap appy in 15-20 minutes. It's like they push the roc and i pray...

Using rocuronium for short cases is completely acceptable...you just have to get out of the mindset of pushing the "standard induction dose" of 0.7 mg/kg. A patient does not require 0/4 twitches to be intubated. In fact, I often like to use rocuronium for short laparoscopic cases like an appendectomy because it provides some degree of relaxation during insufflation and the procedure itself.

But I do agree with the sentiment above that when succinylcholine is the right drug, it is the right drug, and you shouldn't have an unhealthy paranoia about using it. Pushing an RSI dose of rocuronium for a 15 minute case to avoid using succinylcholine is just silly.

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Sure. And because we have blood at the hospital, we don't need to carefully cauterize all bleeding sites.
^^^^^ THIS I will remember and use. :)
 
Using rocuronium for short cases is completely acceptable...you just have to get out of the mindset of pushing the "standard induction dose" of 0.7 mg/kg. A patient does not require 0/4 twitches to be intubated. In fact, I often like to use rocuronium for short laparoscopic cases like an appendectomy because it provides some degree of relaxation during insufflation and the procedure itself.

But I do agree with the sentiment above that when succinylcholine is the right drug, it is the right drug, and you shouldn't have an unhealthy paranoia about using it. Pushing an RSI dose of rocuronium for a 15 minute case to avoid using succinylcholine is just silly.
The question becomes, what is the true RSI dose of roc? So you're saying in an RSI situation in a possible short case, you would just push less roc and hope to get optimal intubating conditions?

And to the other person who brought up the zero twitch attending and then just give suggamadex... does he know the dosing guidelines for Suggamadex? Often times if you have to give it right after a NMBA dose, you have to give like 16mg/kg if they truly have zero twitches. Seems like a poor use of an expensive drug,
 
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Had to bump this up...

So was on call Saturday at my pediatric hospital, and we get an otherwise healthy 14yo male with food impaction (chicken from like 2 days ago...)
So my plan (like usual) is oxygenate, and then RSI with prop, sux, tube and then twiddle thumb.

Wait, I'm confused, you're 10 days away from finishing fellowship, or your attending is? Even after you answer that question, I'll still be confused, because there are so many bad things about your story. Why is a peds-fellowship trained attending half-assing a dose of propofol, then quarter-assing a dose of roc, bagging a pt with a full stomach, and then not reversing?
 
The question becomes, what is the true RSI dose of roc? So you're saying in an RSI situation in a possible short case, you would just push less roc and hope to get optimal intubating conditions?

And to the other person who brought up the zero twitch attending and then just give suggamadex... does he know the dosing guidelines for Suggamadex? Often times if you have to give it right after a NMBA dose, you have to give like 16mg/kg if they truly have zero twitches. Seems like a poor use of an expensive drug,

Just give a priming dose of roc (4-5mg) when you're nearing the end of pre-oxygenation and then induce and give more roc for a total of 0.6mg/kg. Onset of intubating conditions will be ~30-60 seconds vs 90-100 secs. Still would stick with sux if the case is going to be 'truly' 15 minutes.
 
The question becomes, what is the true RSI dose of roc? So you're saying in an RSI situation in a possible short case, you would just push less roc and hope to get optimal intubating conditions

No, I said to push an RSI dose of rocuronium for a short 15 minute case is silly, and succinylcholine is the correct drug choice.

If you are using rocuronium for non-RSI, you can give less than a standard induction dose and still easily intubate the patient.
 
Succinylcholine myalgias suck. I speak from personal myalgic experience. I avoid it when there's no indication for it.

But when it's the right drug, it's the right drug.

Do you use fasciculation and myalgia prophylaxis methods?
 
Do you use fasciculation and myalgia prophylaxis methods?
I give IV lidocaine to almost everyone I intubate.

I'm a fan of preop ketorolac and give it often, when the surgeon isn't looking.

I'm not really a fan of defasciculation doses, because
1) it's even less effective than NSAID and lidocaine pretreatment
2) if I'm using succ it's because I want fast intubating conditions, and succ onset after a defasciculating dose is somewhat prolonged even if you up the dose


For very short cases requiring a tube, I often intubate with small doses of roc. 0.6 mg/kg is double the ED95; half that is good if you don't mind waiting a minute for it to work and/or give it just before the induction agent. 20 mg is usually about the ED95 for a normal sized person, and I don't mind waiting a minute for it to work.

I use succ for RSIs, airways I don't want to wait on, the very rare laryngospasm, and not much else.
 
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