Dismiss Notice
SDN members see fewer ads and full resolution images. Join our non-profit community!

if you were stuck on a desert island

Discussion in 'Anesthesiology' started by mille125, Apr 9, 2007.

  1. mille125

    Joined:
    Dec 8, 2006
    Messages:
    2,132
    Likes Received:
    8
    Status:
    Attending Physician
    If you practiced on a desert island and could only take one drug what would it be? I used to think that this was a no brainer and that I would take ketamine. However, now I feel that I would have to say dexmedetomidine...
     
  2. Thread continues after this sponsor message. SDN Members do not see this ad.

  3. urgewrx

    Joined:
    Mar 16, 2007
    Messages:
    381
    Likes Received:
    1
    Status:
    Attending Physician
    Sux, F'em.
     
  4. mille125

    Joined:
    Dec 8, 2006
    Messages:
    2,132
    Likes Received:
    8
    Status:
    Attending Physician


    lol.......sux and a tube...you would be very feared.......lol
     
  5. militarymd

    militarymd SDN Angel

    Joined:
    Dec 17, 2003
    Messages:
    5,889
    Likes Received:
    14
    Status:
    Attending Physician
    sevoflurane
     
  6. opa beleza?

    opa beleza? Junior Member

    Joined:
    Dec 21, 2005
    Messages:
    36
    Likes Received:
    0
    Status:
    Medical Student
  7. VolatileAgent

    VolatileAgent Livin' the dream

    Joined:
    Jul 6, 2005
    Messages:
    1,039
    Likes Received:
    1
    propofol, without a doubt.
     
  8. VentdependenT

    VentdependenT You didnt build thaT
    Physician Moderator Emeritus

    Joined:
    Oct 3, 2003
    Messages:
    4,011
    Likes Received:
    19
    Status:
    Fellow [Any Field]
    gotta go with mil on this one
     
  9. VolatileAgent

    VolatileAgent Livin' the dream

    Joined:
    Jul 6, 2005
    Messages:
    1,039
    Likes Received:
    1
    how are you going to give it? drip it on some cotton balls and shove them up the person's nose? i mean, we're on a desert island here.

    okay, for the sake of argument, let's say you do have an anesthesia machine. i can still do any case with propofol. you can't with sevo. for example, if you're going to do neuromonitoring then you're screwed with sevo alone. and, you can still give prop to a cardiac patient, despite common prevailing opinion. in fact, we have a couple of cardiac anesthesiologist who use only prop for induction.

    better yet, you uncover through your expert history taking skills that the patient has had an episode of malignant hyperthermia with a prior anesthetic. now what are you going to do?
     
  10. militarymd

    militarymd SDN Angel

    Joined:
    Dec 17, 2003
    Messages:
    5,889
    Likes Received:
    14
    Status:
    Attending Physician
    Having been a military anesthesiologist....and ACTUALLLY having provided anesthesia on a DESERT ISLAND and in other horrible places....your answer typifies what a resident in an academic center would say.
     
  11. VentdependenT

    VentdependenT You didnt build thaT
    Physician Moderator Emeritus

    Joined:
    Oct 3, 2003
    Messages:
    4,011
    Likes Received:
    19
    Status:
    Fellow [Any Field]
    I need a complete anesthetic of which propofol isnt.

    I may need to completely bomb somebody with propofol to inhibit motion leading to disasterous drops in BP and perhaps HR. I may need to crank the volitile as well but at least its fast on fast off...with propofol I'll be clenching my cheeks together for quite a bit longer.

    for hearts I can breath the patient down just as easily as one could titrate in propofol.

    Neuro cases, ok fine I'll run em at 1 mac sevo or lower and see how it goes. SSEP's should still work. If I gotta cancel then so be it.

    Awareness? I got you beat there.

    MH? You got me there.
     
  12. masteropuppets

    Joined:
    Mar 12, 2005
    Messages:
    59
    Likes Received:
    0
    Status:
    Resident [Any Field]
  13. salmonella

    salmonella Gram-Negative Rods

    Joined:
    Dec 14, 2004
    Messages:
    196
    Likes Received:
    2
    A set of acupuncture needles.
     
  14. Gern Blansten

    Gern Blansten Account on Hold

    Joined:
    Jun 20, 2006
    Messages:
    2,143
    Likes Received:
    281
    Status:
    Attending Physician
    That is one helluva desert island. Are they hiring?:)
     
  15. Gern Blansten

    Gern Blansten Account on Hold

    Joined:
    Jun 20, 2006
    Messages:
    2,143
    Likes Received:
    281
    Status:
    Attending Physician

    I believe this choice is the one that would save the most lives, if there are lives to be saved on a desert island.

    By desert island, do you mean deserted as in no one on it? If so, what is the use? Or do you mean an island that is primarily desert? Or is it the "Dessert Island" at the Western Sizzlin'. Or did you mean an island inhabited by Mormons where the phonetic alphabet designed by Brigham Young (the Deseret) is the primary alphabet? My answer would be different for each of these instances.:)
     
  16. Thread continues after this sponsor message. SDN Members do not see this ad.

  17. VolatileAgent

    VolatileAgent Livin' the dream

    Joined:
    Jul 6, 2005
    Messages:
    1,039
    Likes Received:
    1
    neither is sevo. that's why we have the concept of "balanced anesthesia", and why we're talking hypothetical situation here as well.

    you're not waiting long enough. having done MANY (dozens) of propofol-only anesthetics for everything from neuro cases to fistulotomies in prone position, i can tell you that the biggest problem is that people expect that they can start cutting as soon as the patient's eyes are shut. you gotta wait. if you think they're "under" when they close their eyes, they're going to move. but, if you bolus 500mcg/kg to get their eyes shut, then run them at 200mcg/kg/min for about 10-12 minutes before any surgical stimulation (ie., it's okay for them to prep), you'll have no problems. don't guess. use a pump. the best thing is that most patients will spontaneously breathe at this dose as well. they won't move. and they sure as hell won't remember a damn thing. you might drop the SBP by about 10-20mmHg, but nothing else will happen. if they stop breathing, just pop an LMA in.

    tell the surgeon to be patient (no pun intended), or start your infusion far earlier before surgical stimulation. don't guess by floating it in with little boluses here and there. if you're "bombing" them, you're doing it wrong. propofol is not now nor was it ever designed to be a bolus agent. that's why people's bp drops. even during induction, you're supposed to slowly infuse it over 30 seconds. knowing that, watch how many of your attendings administer it incorrectly. then, do it yourself with a slow infusion and watch how much smoother the induction is and without any big drops in BP.

    and, i'm not talking about adding midaz or fent or anything else. you can do a whole case with propofol alone. i know. i've done it... too many times to count.

    but, the biggest advantage? do a few propofol-only cases and watch how nicely, happily, clear-headed, and non-puking your patients wake up. you'll never want to use another agent, especially for short cases, again.
     
  18. VolatileAgent

    VolatileAgent Livin' the dream

    Joined:
    Jul 6, 2005
    Messages:
    1,039
    Likes Received:
    1
    i'll share that comment with the person who taught me this technique. he only happens to have been practicing anesthesiology for 30 years, both private and academic, and has written one of the most widely used cardiac anesthesiology texts. i'm sure he'll get a chuckle from your comments.
     
  19. johankriek

    johankriek Banned
    Banned

    Joined:
    Jul 19, 2006
    Messages:
    921
    Likes Received:
    1
    Status:
    Post Doc
    evangeline Lilly or
    salma hayek
    or ashlee simpson ( i like her better than jessica)
    scarlett johannson
     
  20. jeesapeesa

    jeesapeesa anesthesiologist southern california

    Joined:
    Apr 1, 2007
    Messages:
    260
    Likes Received:
    8
    Status:
    Attending Physician
    Two words....Marisa Miller (not related to Miller Anesthesia)
     
  21. urgewrx

    Joined:
    Mar 16, 2007
    Messages:
    381
    Likes Received:
    1
    Status:
    Attending Physician
    Can you do a lap chole with that technique? Breast reduction? Even a colectomy?
     
  22. VentdependenT

    VentdependenT You didnt build thaT
    Physician Moderator Emeritus

    Joined:
    Oct 3, 2003
    Messages:
    4,011
    Likes Received:
    19
    Status:
    Fellow [Any Field]
    sco-joh for sure man

    I've only used propofol as my sole anesthetic for a bone biopsy (ran infusion at 150 after a 30-40mg bolus) and hip distractions (big slug).

    otherwise I have something elso on board

    We use a tiva type method here thats propofol based for general cases/mh/severe ponv and there is always NMB/opiate on board as well as some n20 (for awareness per attending). So I cant say I've run someone at 200 or > mcg/kg/min on the tripple pump for any extended duration of time. I will say that the stuff is nice.

    On the other hand I have used sevo for hours on end without the additional need for opiate/nmb. So I suppose its user experience.

    I'd certainly like to try propofol based general anesthesia more often for outpatient cases.

    vent
     
  23. Noyac

    Noyac ASA Member
    SDN Advisor

    Joined:
    Jun 20, 2005
    Messages:
    7,414
    Likes Received:
    1,973
    Status:
    Attending Physician
    Ketamine

    It can do it all.
     
  24. Planktonmd

    Moderator Emeritus Lifetime Donor Classifieds Approved

    Joined:
    Nov 2, 2006
    Messages:
    6,770
    Likes Received:
    1,687
    Status:
    Attending Physician
    yes Ketamine no doubt.

    The reason I did not say Precedex is because it does not give good amnesia.
     
  25. mille125

    Joined:
    Dec 8, 2006
    Messages:
    2,132
    Likes Received:
    8
    Status:
    Attending Physician


    those are my thoughts as well....however, i tend to like dexmedetomidine more and more....ketamine is a very good choice.......i like sevo as well
     
  26. urgewrx

    Joined:
    Mar 16, 2007
    Messages:
    381
    Likes Received:
    1
    Status:
    Attending Physician

    When I first started playing with precedex I put one vial (200 mcg if I remember correctly, haven't used it in a while) in a 100ml bag with a micro drip FULL OPEN! In 10 or 15 min it was gone. That pt did not wake up in 4 hrs!! Didn't even react to pain. Actually looked dead, but was breathing. That's a funny drug for sure.
     
  27. dhb

    dhb Member
    Lifetime Donor Classifieds Approved

    Joined:
    Jul 12, 2006
    Messages:
    3,431
    Likes Received:
    620
    Status:
    Attending Physician
    HAHA love that, when people look at you like you've killed the guy. Too bad precedex never penetrated the european market .. but we have clonidine

    back to the o question: Ketamine
     
  28. rn29306

    rn29306 Drugs are bad, m'kay?

    Joined:
    Oct 30, 2004
    Messages:
    422
    Likes Received:
    1
    Status:
    Post Doc

    Would loved to have heard the discussion with the family after this patient's surgery as for the explanation of this fiasco..
     
  29. TIVA

    TIVA Member

    Joined:
    Jun 7, 2006
    Messages:
    151
    Likes Received:
    1
    Status:
    Attending Physician
    Didn't the patient go bradycardic or hypertensive on you?
     
  30. TIVA

    TIVA Member

    Joined:
    Jun 7, 2006
    Messages:
    151
    Likes Received:
    1
    Status:
    Attending Physician
    Best anesthetic on a deserted desert island: Russian vodka
     
  31. johankriek

    johankriek Banned
    Banned

    Joined:
    Jul 19, 2006
    Messages:
    921
    Likes Received:
    1
    Status:
    Post Doc
    especially violent nightmares, salivation, and suicidal ideation for weeks after......
     
  32. urgewrx

    Joined:
    Mar 16, 2007
    Messages:
    381
    Likes Received:
    1
    Status:
    Attending Physician
    HR was in the 50's. BP dropped around 20 points. Didn't require any intervention for this. Breathing spontaneously with a normal rate. Not doing anything else, though.
     
  33. Noyac

    Noyac ASA Member
    SDN Advisor

    Joined:
    Jun 20, 2005
    Messages:
    7,414
    Likes Received:
    1,973
    Status:
    Attending Physician
    So what's your point? The question states that you have only one drug. Those things are easy to fix if you can have more than one drug.
     
  34. epidural man

    epidural man ASA Member

    Joined:
    Jun 3, 2007
    Messages:
    2,810
    Likes Received:
    551
    Status:
    Attending Physician

    There are case reporst of using precedex as a sole anesthetic. I think some used 10x the recommended dosages.

    I like ketamine though.
     
  35. BlackSails

    Joined:
    Apr 4, 2007
    Messages:
    865
    Likes Received:
    3
    Status:
    Pre-Medical
    Cesium. Sure, its not an anesthestic agent, but every time I see a plane or boat, I toss a chuck into the water.
     
  36. jetproppilot

    jetproppilot Turboprop Driver

    Joined:
    Mar 12, 2005
    Messages:
    5,861
    Likes Received:
    97
    CORONA.

    ...the island probably has a lime tree too......
     
  37. ketamine

    many 3rd world countries do whole cases with ketamine only.
     
  38. pd4emergence

    pd4emergence Man or Muppet?

    Joined:
    Jun 10, 2007
    Messages:
    558
    Likes Received:
    14
    Status:
    Attending Physician
    A case of Jack Daniels.
     
  39. VentdependenT

    VentdependenT You didnt build thaT
    Physician Moderator Emeritus

    Joined:
    Oct 3, 2003
    Messages:
    4,011
    Likes Received:
    19
    Status:
    Fellow [Any Field]
    HAHA YEAH BOY!

    I want to change my answer from SEVO to Staropramen Lager. There is ICE on this island right?
     
  40. Planktonmd

    Moderator Emeritus Lifetime Donor Classifieds Approved

    Joined:
    Nov 2, 2006
    Messages:
    6,770
    Likes Received:
    1,687
    Status:
    Attending Physician
    Yes, if you use 10 times the dose they will get severely hypotensive, and brain hypoperfusion is a great amnestic :)
     
  41. epidural man

    epidural man ASA Member

    Joined:
    Jun 3, 2007
    Messages:
    2,810
    Likes Received:
    551
    Status:
    Attending Physician
    Exactly! That is why I break all my laryngospasms with hypoxia - it breaks eventually, right?:)

    Actually, the problem at high doses is hypertension. The alpha-1 starts to kick in.
     
  42. Planktonmd

    Moderator Emeritus Lifetime Donor Classifieds Approved

    Joined:
    Nov 2, 2006
    Messages:
    6,770
    Likes Received:
    1,687
    Status:
    Attending Physician
    I believe you are right.
     
  43. Noyac

    Noyac ASA Member
    SDN Advisor

    Joined:
    Jun 20, 2005
    Messages:
    7,414
    Likes Received:
    1,973
    Status:
    Attending Physician
    Jet, I heard that here was a secret ingredient in the corona's. I heard it was PISS.


    Thats why I like Pacifico:laugh:

    Or Negro Modelo
     
  44. jetproppilot

    jetproppilot Turboprop Driver

    Joined:
    Mar 12, 2005
    Messages:
    5,861
    Likes Received:
    97
    Man, them Mexicans sure have great tasting urine then!
     
  45. epidural man

    epidural man ASA Member

    Joined:
    Jun 3, 2007
    Messages:
    2,810
    Likes Received:
    551
    Status:
    Attending Physician
    I've always wanted to induce anesthesia with 3 cc's.

    1cc ketamine, 2cc's of sufenta, use this solution to disolve 10mg vecuronium.

    I don't know - it sounds cool to carry around a 3cc syringe of complete anesthsia.
     

Share This Page