ICU intubation

[sevoflurane]

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Esmolol controls the heart rate, not the hypertension. So you can mix different drugs to get the desired effect or just use 2 prop/alfenta or remi easy fast and 100% effective (for the hemodynamics not the quality of intubating conditions)

That is what the propofol and 5 puffs of Sevo are for (before laryngoscopy). 😉

As for the alfenta/prop approach... Well, I've done 5 cases this week intubating (w/o) relaxant + prop/alfenta.

1st = need a big dose of propofol
2nd = alfenta controls HTN/tachy very well (as you would expect). Intubating conditions were decent, but nothing like roc or sux.
3rd = takes a little practice. I got a little bucking after my first 2 🙂( I like to look slick with zero bucking), which is when I learned that I need to give the better part of a whole stick of the white stuff vs. 130-150mg I usually give (generally). Alfenta needs to be given well in advance in order to get maximal effect. Like 2-3 minutes (patient in room/monitors going on)- watch out for bradycardia.

In the end... I don't see a major advantage over fent (unless you want something on and off real quick... but that is what sux is for). As far as I know, alfenta doesn't have muscle relaxing properties.

I'm most concerned with intubating conditions, everything else I can take care of with a plethora of other drugs. Weather it's alfenta, sevo, more propofol, esmolol, dilaudid, sufenta, magnesium, NTG, etc... well that's just dealers choice.

🙂

 

[sevoflurane]

My n=5, so I may just need some more time with this approach.🙄

 

[dhb]

Oh yeah studies have all been done with +- 2.5mg/kg of propofol so i'm almost always pushing the whole stick.
I don't know about the alfenta, remi has worked fine for me with intubating conditions equal to roc 1min after induction so i don't feel the need to try out alfenta.

 

[epidural man]

That is what the propofol and 5 puffs of Sevo are for (before laryngoscopy). 😉

As for the alfenta/prop approach... Well, I've done 5 cases this week intubating (w/o) relaxant + prop/alfenta.

1st = need a big dose of propofol
2nd = alfenta controls HTN/tachy very well (as you would expect). Intubating conditions were decent, but nothing like roc or sux.
3rd = takes a little practice. I got a little bucking after my first 2 🙂( I like to look slick with zero bucking), which is when I learned that I need to give the better part of a whole stick of the white stuff vs. 130-150mg I usually give (generally). Alfenta needs to be given well in advance in order to get maximal effect. Like 2-3 minutes (patient in room/monitors going on)- watch out for bradycardia.

In the end... I don't see a major advantage over fent (unless you want something on and off real quick... but that is what sux is for). As far as I know, alfenta doesn't have muscle relaxing properties.

I'm most concerned with intubating conditions, everything else I can take care of with a plethora of other drugs. Weather it's alfenta, sevo, more propofol, esmolol, dilaudid, sufenta, magnesium, NTG, etc... well that's just dealers choice.

🙂

👍

Cool post. More Alfenta?