Could someone please answer this question? Is the use of IV lidocaine in the perioperative period only to decrease the need for opiod use? I was in a case ( just hanging out and learning as I will not be starting residency until 2011) and the anesthesiologist used lidocaine when the pt was waking up a bit to early from the procedure he than gave propofol soon after. He said that sometimes lidocaine is enough to calm the pt back down and I assume that would just be in regards to pain control and have nothing to do with sedation. My thought process here is that is the pt would be assumed to have enough sedation on board to keep him calm if his pain was lessened by the use of the slug of IV liodcaine ( it didnt work hence the use of propofol very soon after). I cant seem to find a good answer or discussion in my books or on-line. Thanks
IV lidocaine
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I believe lidocaine or anyother local can lower you required MAC for a given volitale agent, thereby increasing your level of anesthesia when not all the volitale is off yet.... I am assuming this is what your anesthesiologist was getting at...not so much for decreasing opitate use when the pt is bucking about... That being said, I usually go straight to propofol in that case. I have only really used IV lidocaine to blunt the DL, prevent the propofol burn, and treat some arrythmias. Never for decreasing MAC or what have you.
Speaking of decreasing perioperative opiate use, anyone using ketamine on regular basis?? gtts vs bolus or what??
Speaking of decreasing perioperative opiate use, anyone using ketamine on regular basis?? gtts vs bolus or what??
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Depending on the dose of IV lidocaine, it can be used to help patients tolerate remaining intubated while not completely "deep" under anesthesia.
It's one option to answer a common oral boards question re: various methods to keep a post-surgical patient "comfortable" while intubated, but alert enough to respond to a neurologic exam.
I'm assuming the person you observed was using lidocaine to blunt responses to the ETT tube and then ultimately a touch of propofol to sedate the patient a touch since case was close to end.
It's one option to answer a common oral boards question re: various methods to keep a post-surgical patient "comfortable" while intubated, but alert enough to respond to a neurologic exam.
I'm assuming the person you observed was using lidocaine to blunt responses to the ETT tube and then ultimately a touch of propofol to sedate the patient a touch since case was close to end.
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Lidocaine blocking the response to DL has been proven untrue. It can lower your MAC and lower your opioid requirement in the post operative for some types of surgeries.
As for ketamine i almost always mix it up with the opioid i'm going to use in a 1 to 4 ratio : 4cc sufenta 1cc K which gives me in 1 cc 10mg of K for 4 mcg of sufenta. I'll bolus this or use as a continuous infusion on long cases.
For post-op infusions i think you should use around 1mg/kg/24h
As for ketamine i almost always mix it up with the opioid i'm going to use in a 1 to 4 ratio : 4cc sufenta 1cc K which gives me in 1 cc 10mg of K for 4 mcg of sufenta. I'll bolus this or use as a continuous infusion on long cases.
For post-op infusions i think you should use around 1mg/kg/24h
