if you were stuck on a desert island

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mille125

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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...
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Sux, F'em.
 
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VentdependenT said:
gotta go with mil on this one
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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?
 
VolatileAgent said:
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?
Click to expand...

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.
 
VolatileAgent said:
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?
Click to expand...

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.
 
A set of acupuncture needles.
 
VolatileAgent said:
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?
Click to expand...

That is one helluva desert island. Are they hiring?:)
 
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opa beleza? said:
imipenim:thumbup:
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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.:)
 
VentdependenT said:
I need a complete anesthetic of which propofol isnt.
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neither is sevo. that's why we have the concept of "balanced anesthesia", and why we're talking hypothetical situation here as well.

VentdependenT said:
I may need to completely bomb somebody with propofol to inhibit motion leading to disasterous drops in BP and perhaps HR....
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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.
 
militarymd said:
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.
Click to expand...

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.
 
evangeline Lilly or
salma hayek
or ashlee simpson ( i like her better than jessica)
scarlett johannson
 
Two words....Marisa Miller (not related to Miller Anesthesia)
 
VolatileAgent said:
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.
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Can you do a lap chole with that technique? Breast reduction? Even a colectomy?
 
johankriek said:
evangeline Lilly or
salma hayek
or ashlee simpson ( i like her better than jessica)
scarlett johannson
Click to expand...

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
 
Planktonmd said:
yes Ketamine no doubt.

The reason I did not say Precedex is because it does not give good amnesia.
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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
 
mille125 said:
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
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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.
 
urgewrx said:
Actually looked dead, but was breathing.
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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
 
urgewrx said:
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!!
Click to expand...


Would loved to have heard the discussion with the family after this patient's surgery as for the explanation of this fiasco..
 
urgewrx said:
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.
Click to expand...

Didn't the patient go bradycardic or hypertensive on you?
 
Best anesthetic on a deserted desert island: Russian vodka
 
TIVA said:
Didn't the patient go bradycardic or hypertensive on you?
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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.
 
johankriek said:
especially violent nightmares, salivation, and suicidal ideation for weeks after......
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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.
 
Cesium. Sure, its not an anesthestic agent, but every time I see a plane or boat, I toss a chuck into the water.
 
mille125 said:
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...
Click to expand...

CORONA.

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

many 3rd world countries do whole cases with ketamine only.
 
Planktonmd said:
Yes, if you use 10 times the dose they will get severely hypotensive, and brain hypoperfusion is a great amnestic :)
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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.
 
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.
 
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