Busy ENT Room

[Mman]

Fortunately I train at a place where most of the attendings are self aware enough to recognize everyone does things differently. But it still doesn’t stop them from demanding you do it their way when with them... and chewing you out when you don’t.

The entire point of residency is to learn different ways of safely doing an anesthetic so it's good learning to see and practice those different ways.

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[btbam]

No one uses Mivacron for these cases?

 

[kmurp]

No one uses Mivacron for these cases?

Used to use it routinely. Then it became unavailable and is off formulary. It worked great.

 

[btbam]

Used to use it routinely. Then it became unavailable and is off formulary. It worked great.

It was off the market for like 10 years and we just got it back about 8 months ago.

 

[jwk]

Don’t give sux. Low dose roc/vec. Titrate as necessary keeping them reversible but weak throughout the case. This will let you come way down on the amount of anesthesia/narcs you’re giving them. No sugg necessary. Obviously that won’t jive with neuromonitiring, but what cases are you monitoring aside from thyroids and parathyroids? Those cases have some closure time to work with anyways.

For fast ENT like pedi tonsils, no NMB is necessary. Get em deep, and give moderate dose lidocaine after the IV - maybe 4mg/kg. Opioid of choice (we don't even have remi on formulary so that's a moot point).

 

[jwk]

Used to use it routinely. Then it became unavailable and is off formulary. It worked great.

Movacron?

 

[deleted162650]

For fast ENT like pedi tonsils, no NMB is necessary.

Agree 100%. I don’t paralyze kids at all.

 

[btbam]

Fast ENT sure, but we have PGY 1s and 2s doing T+As for the first time, so there's nothing quick about it.

 

[dchz]

I've never understood this. You have 3 years to do anesthesia. The whole point of intern year is to be a secretary.

Fixed that for ya.

 

[dchz]

Tramadol 2mg/kg
Parecoxib 1mg/kg

are you hitting the COX enzyme twice? what did i miss here?

Edit:

i misread tramadol =/= toradol.

 

[dchz]

But my attendings said their way is the only way, and any other way is wrong. Meaning how every other attending does their thing is wrong according to each other. How does that work?

You have plenty of time to figure that out while the CRNA does your central line for ya.

 

[DocVapor]

are you hitting the COX enzyme twice? what did i miss here?

That he said tramadol, not toradol?

 

[dchz]

That he said tramadol, not toradol?

HAHAHAH! you're right, i read what i wanted to read.

 

[DocVapor]

HAHAHAH! you're right, i read what i wanted to read.

I knew what you did from experience. I would bet the same for many posters here.