How do you do your average cardiac case?

[Airlife91]

Anyone using methadone during cardiac cases? Some interesting (relatively) recent studies in both cardiac and spine cases to support its use.

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[itwasalladream]

We used it occasionally in training. 10-20mg IV after induction. I didn't have any issues with it, but also can't confidently say it made a difference. I do think that, after seeing all the variety in fentanyl, midaz, sufenta, etc. dosing, what matters most for early post-op extubation is the culture and extubation protocols of the ICU.

This review made me a lot more interested/confident about using methadone:
Intraoperative methadone: Rediscovery, reappraisal, and reinvigoration?

It definitely has some cool properties.

 

[dchz]

This review made me a lot more interested/confident about using methadone:
Intraoperative methadone: Rediscovery, reappraisal, and reinvigoration?

Hmmmmm.... if you read the article and original references, the studies were done on gen surg and ortho cases... I find that the most interesting. Anyone use methadone as 1st line cases in ortho and gen surg if they know the case will be > 2 hours?

 

[AdmiralChz]

Anyone using methadone during cardiac cases? Some interesting (relatively) recent studies in both cardiac and spine cases to support its use.

Methadone is tightly controlled in many states (including mine) and getting state & hospital pharmacy approval to administer it can be a huge hurdle.

 

[pgg]

Methadone is tightly controlled in many states (including mine) and getting state & hospital pharmacy approval to administer it can be a huge hurdle.

Really? Is it treated differently than fentanyl?

Getting IV methadone is sort of a pain for us because it's not stocked in the OR. We have to get it from the pharmacy. But aside from the 10 minute hassle, it's no big deal.

 

[partydoc]

We're on a shortage

 

[Globulinus]

Anyone using methadone during cardiac cases? Some interesting (relatively) recent studies in both cardiac and spine cases to support its use.

Usual preop cocktail would be Gabapentin 600mg/ Methadone10-20mg PO
Tylenol IV pre incision
Avoid Versed if feasible (no more then 2 mg for the case or not at all)
Fentanyl no more then 500mcg for the case
Precedex for ICU transport