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Epidural?
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for a lap chole? no thanks.
Yeah sticking a needle in the spine of a lunatic and keeping her awake during surgery is gonna work out greeeaaaat ...
🙂
Midazolam is a great induction drug, if you don't mind admitting the patient overnight. Maybe remimazolam will show up someday.
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This is an allergy list from a patient in a case that I took over from a CRNA in residency CA1 year. It is one of the most ridiculous I've seen (not the longest or craziest, but ridiculous). I try to clean up allergy lists when I can, but sometimes, I don't feel like fighting. I had a patient swear she was allergic to epinephrine because her heart raced; she was very mad at me when I said that's not an allergy.
Epidural
I'm not anesthesia lol but thought I'd take a crack at it since I read these forums. I know neuraxil has been done for abdominal surgeries before.
Spinals are done routinely in many parts of the world for intra abdominal procedures because it's a $1 anesthetic and the patients are motivated/stoic. Not really a great patient experience in many cases though.
Dosing and context sensitive half life are the issue, as is the fact that patient response to benzos is quite variable. 2 mg of midazolam given for anxiolysis won't be an issue. 15 mg as an induction dose is going to zonk a lot of people for hours and hours. Some will have a full day memory hole. Can be hard to discharge those people.
High dose benzos are a wonderfully smooth inductions, but they come with some baggage.
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I had a patient who brought a sheet like that. One of the entries was “all Eli Lilly drugs”.
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Hilarious.
what did they have against Eli Lilly?
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Do just that every once in a month or so. Thing is, once we let the pacu nurses know "this may look a bit funky, but it's due to the drugs we had to use", they're pretty compliant. Patients, too, for that matter.I mean, for a normal ketamine induction, I rarely give more than 2.5 of midaz to smooth things over.
And it should've been what the idiots in Canada had done. Or even thio, which as far as I know is very much available in Canada, eh?
