anesthesia question

[premedwannabe12]

I was shadowing an anesthesiologist the other day and I noticed doctors administrating pain reliever for the anesthesia itself. I was going to ask about this but somehow the topic changed,… can someone plz explain this procedure?

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[Transmuralmi]

Was it general anesthesia or local? Your question is a bit too vague to answer. Often opiate analgesics are included in induction of anesthesia.

 

[LizzyM]

@CodeBlu

 

[jsf0120]

Depending on the sequence, many anesthesiologists I work with choose to include lidocaine in their propofol and/or rocuronium syringes. Many patients complain of burning or tingling in their "IVs" and this seems to help. I've also seen them give lidocaine by itself before any of the induction drugs to help combat this.

 

[jsf0120]

So its for the discomfort while administering the anesthesia prior to the anesthesia taking effect?

Correct! Usually the tingling/burning sensation lasts no longer than it takes to say "You might start feeling some discomfort here in the IV, that's the medicine going in" before they drift off.
When I asked why, I got a few different answers, one vague response about the emollient characteristics of the propofol, another about the preservative in the mixture.

 

[CodeBlu]

I was shadowing an anesthesiologist the other day and I noticed doctors administrating pain reliever for the anesthesia itself. I was going to ask about this but somehow the topic changed,… can someone plz explain this procedure?

@CodeBlu

Sorry, I realize this is a delayed reply. Being on call all the time doesn't afford me the ability to be on SDN as much. Thanks to @LizzyM for tagging me in this pst.

Induction of anesthesia is not as simple as rocketing in drugs as fast you can. You'll probably hear the joke... prop. sux. tube.

A really smooth induction (when you're not doing a rapid sequence, that's another story) is one where the following criteria are met:

1) You've allowed your opioid (usually fentanyl or sufentanil) to circulate for 3-4 minutes allowing time for it to take effect
2) You titrate your propofol/etomidate/thiopental to loss of consciousness.
3) +/- paralysis (rocuronium, sux)
4) relative stability of hemodynamic variables (ex. your heart rate doesn't shoot up to 140 following your laryngoscopy)

Now, I never mix lidocaine into my propofol syringe. There's evidence to show it alters the physiochemical stability of the propofol and can cause PE.

The lidocaine that I give is in a separate syringe... and it serves A LOT of purposes.
1) It can numb the vein so that the propofol doesn't sting so much. But, if you're using a big vein, it doesn't hurt as much. (*** see below)
2) Blunts the pharyngeal response to intubation (opioids accomplish this as well)
3) Has a mild-moderate sedative effect (decreases the amount of anesthetic gas you have to give someone initially... if you run an infusion of lidocaine, you can theoretically run a lower gas vol%, but the evidence is sparse for this in humans)
4) Helps to treat a component of neuropathic pain

To effectively use your lidocaine for the pain of propofol injection, you really should tie a tourniquet above the IV site and wait 60-90 seconds for the lidocaine to cause a Bier block. Most people are impatient to do this and just inject all of it in one fell swoop.

Moral of the story? If you want to inject propofol to induce anesthesia, you can give some lidocaine which is multipurpose.