Visited a friend on the west coast during the week of Thanksgiving and found out that he does this on a semi frequent basis for high paying customers.
To recap what he does:
Patient and family read the riot act and informed of the potential risks involved (AUA, death, CVA, MI, etc.).
Next step is comprehensive blood work and stress echo based on age and risk factors.
Waivers signed. Ready to go.
Standard GETA induction, lubricated ETT, Forane, multiple infusions ready to go including nicardipine, esmolol, epinephrine, levophed, cisatracurium, lidocaine or amiodarone, sufentanil depending on type of addiction, phenytoin, and some type of TPA.
Monitors: standard plus CVP, large bore IV, A line, and EEG.
Usually takes about 48 hours for him for one patient, sometimes 72 hours. He stays in house, but as this is not a surgical procedure, he is in comfortable clothing and can usually sleep in 6-8 hour increments.
The amiodarone, esmolol, and nicardipine are the keys to a smooth rapid detox. The esmolol is quickly metabolized when shut off and allows for a rapid assessment of the patient's autonomic responses.
His final criteria for termination of GA are stable vital signs for 4-6 hours after termination of all infusions except TPA, stable body temperature, appropriate pupillary reflexes, and normal response to noxious stimuli.
He has done 34 of them thus far at a private facility, including two notable celebrities without mortality, although one older patient suffered a minor CVA, which was prior to the more thorough workup that he now requests as well as prior to the use of nicardipine and dilantin.
Charge per patient? Facility fees plus his $50K up front fee. This type of detox is NOT sanctioned by the state medical board, but it is available to anyone who thinks a quick fix rapid detox is better than a balanced and gradual withdrawal with psychosocial support systems in place.
