This took me two minutes to find.
Now you present some contrary evidence. I'll give you more time than two minutes.
I love how in papers they observe an effect and then just make up a phiological concept to justify it.Our results suggest that acute fentanyl tolerance develops after administration of high dose fentanyl
during surgery and, consequently, results in a higher postoperative pain intensity and greater fentanyl consumption.
Imho, if you saturate your opiod receptors during surgery it seems obvious that you are going to need higher doses to treat post-operative pain.
I will often do prop infusion for any high risk ponv case/pt. Setting up a bottle of prop takes me about 30 seconds.
I think the general anecdotal impression of most is that a prolonged prop infusion will linger longer than sevo or des, so people will be more awake and feel better quicker post op after gas. I generally do TIVA only if there’s concern for nausea, neuromonitoring, maybe if I want a smoother emergence. How often are you seeing people wake up more awake after a long TIVA case?I am a little surprised at the disdain on here against TIVA....in fact some really need to make that point that it isn't any better.
As the protagonist from Green Eggs and Ham says, try and you will see! I know you all think you are very experience with TIVA, and great if you are and you hate it, but if you aren't...try getting experienced. Try not having to worry about laryngospams (to the same degree) at the end of the case. Try seeing how people feel after a long propofol infusion vs a sevoflurane anesthetic. Try not having to worry about getting someone through stage II. It's really good stuff. I'm really really surprised it is used so little.
But again...people are strange. Try telling someone they should eat more broccoli and avoid milk and meat and people have a nervous breakdown.
I think the general anecdotal impression of most is that a prolonged prop infusion will linger longer than sevo or des, so people will be more awake and feel better quicker post op after gas. I generally do TIVA only if there’s concern for nausea, neuromonitoring, maybe if I want a smoother emergence. How often are you seeing people wake up more awake after a long TIVA case?
Did a TIVA the other day for what was supposed to be a 3 hour lap gyne case... turned into an 8 hour open gyne case. Running propofol and a sufentanil infusion at 0.2mcg/kg/hr.... turned sufentanil off 2 hours before “emergence”... prop off as they start to close fascia. This lady took her sweet sweet time waking up.
Breathing was fine.... would open her eyes. But... then close them again.
Brought her intubated to PACU. She slept for another 2 hours comfortably on PS8/5. Then woke up.
I’m no TIVA expert... but, I find that even with “short” context sensitive half time drugs like sufentanil etc.... sometimes that stuff adds up over time.
Anyways, she didn’t have any nausea/vomiting which was the main reason for the TIVA. So that was a win.
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I read a great quote about REMI one time. Someone wrote (with regards to if they use REMI)...."REMI is like standing up in a canoe. Sure I COULD stand up in a canoe, but why would I ever want to?"
We are all taught that anesthesia messes with sleep/wake cycle (as does surgery). But that is mostly with volatile anesthetic. In fact, if you have a sleep deficit, volitile anesthetic makes this worse.
I am a certified, card-carrying Remi hater.
The worst offender for this is Precedex. I know several staff anesthesiologist who had dex infusions as part of clinical studies on its effects on neuromonitoring. They all hated it because it F'd up their sleep cycles for 3-4 days post infusion.
Depends on your goal I guess. The line is flatter with algebra up than with sufenta, but it does last longer. I used to do sufenta more as a resident.Why alfenta? Sufenta has a much better context sensitive half-life. Man I miss that drug (haven't had it on formulary since residency).
Just curious, why not?I’ve used it successfully for MAC laryngoplasties as well. It has its uses but routine GA’s and spines aren’t one of them.
It’s a great drug for people that aren’t great at anesthesia.
Just curious, why not?
It is a great way to decrease total mac requirements, it has analgesic properties, and slows heart rate. I rarely do infusion but 20mcg bonuses can be very effective I think.
They also do all of their central lines without ultrasound, A-lines with no wires. Lines placed pre-induction with no local and *somehow* the patients survive.
Some people in my class did a trip to SE Asia. They came back with video of doing parasthesia technique nerve blocks on 7yo kids with no sedation and the kids just laid there and took it like a champ. We’re such p*ssies here.
We had an elective CA-3 rotation in China, I didn't make it over there but according to everyone that went, every single case is TIVA.
They also do all of their central lines without ultrasound, A-lines with no wires. Lines placed pre-induction with no local and *somehow* the patients survive. I imagine that using anatomical landmarks is easier when most people are regular sized, not USA jumbo-sized. Apparently, one time a patient with a BMI of 32 showed up and everyone started losing their minds, discussing what special precautions should be undertaken to do the case safely.
*somehow* the patients survive