Induction agent titration

[DrDre']

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Jet, as always, got me thinkin...

I feel like I am using much more propofol throughout this year, myself. I have no other experience base but I swear i am using 25% more than prior. And with the same hemodynamics s/p induction...

So has there been a recent change or am i just sniffin paint here?


2nd and more important question for you Jedis of the Gas....

How many of you ROUTINELY "titrate" your IV induction agent vs. slammin in the syringe?

I am not speaking of the super sick vasculopath, trauma pt, ASA 5E, etc

We have one doc who ALWAYS titrates it in and uses 1/3 to 1/4 of what everyone else uses just by taking 30-60 secs to do it rather 5 secs

 

[Idiopathic]

If no RSI, then I give about half what I would have back in August and just wait 20 seconds. Big dudes and young people obv require more and Ill dose them up, but I dont have a problem with just giving what is needed and not slamming 2 per kilo into everybody.

Sort of like how i used to run a full MAC, with full neuromuscular blockade. Dont do that anymore

 

[dhb]

2nd and more important question for you Jedis of the Gas....

How many of you ROUTINELY "titrate" your IV induction agent vs. slammin in the syringe?

I am not speaking of the super sick vasculopath, trauma pt, ASA 5E, etc

We have one doc who ALWAYS titrates it in and uses 1/3 to 1/4 of what everyone else uses just by taking 30-60 secs to do it rather 5 secs

I'm sort of in the middle: i give a give a little 40-50mg slam and the rest slowly i rarely need more that 150mg of the white stuff. One attending does the slow-mo but then you still have to give more prior to intubation to achieve a deeper plane.

 

[Noyac]

I probably give 2/3 to 1/3 of the amount of propofol that I gave when I was a resident. The elderly get 1/3 and the others usually get about 1/2 to 2/3's. If I'm placing an LMA I give a bigger dose but for ETT's I have really cut back.

I usually have 5-8cc of the 20cc bottle left at the end of the case and I give 2-5 cc at the end of the case.

 

[coprolalia]

How many of you ROUTINELY "titrate" your IV induction agent vs. slammin in the syringe?

I induced a 90-year-old, 105kg woman the other day with 50mg propofol and 100mcg of fentanyl. It took two minutes from the "bolus" to adequate intubating conditions. Her only saving grace was that she had good lungs despite everything else being piss poor (fat, multiple prior lower extremity fractures, etc.).

You can always overwhelm impatience with larger doses of induction agent.

-copro

 

[DrRobert]

For RSI I give the full 2 mg/kg. For standard inductions I am trying hard to titrate and resist the urge to push the entire syringe.

 

[BISof60]

Healthy outpatients, I'm a slammer. 15-18mL to induce, save a few cc's for end of case.