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- Oct 18, 2001
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To the Jedi of anesthesia,
I've been trying some new things out for my run-of-the-mill cases. One of our newer attendings introduced PFK anesthesia, and as a corollary, expanded the use of low-dose (less than 50mg/case) ketamine.
As part of my new induction regimen, 1-2mg versed, ~25mg ketamine, 150-200mg propofol, sux/vec and tube/LMA. Maint with Sevo/Propofol or Sevo/N2O. Titrate narcotic based on hemodynamics (yes, bad idea, but I'm human), expected hourly requirement, etc.
End of the case is where things get interesting. We have PSVPro on our machines so it's rare not to have the patient spontaneously breathing throughout the remainder of the case. Agents off; by end of dressing <0.05 agent, N2O <10% ET and if propofol off >15-20 minutes (after running 50-100 mcg/kg/min for the case as an adjunct to spare inhalational).
Patient with a smile on their face, breathing regularyly and comfortably with appropriate gag to suction, but won't wake up. Pull tube while patient deep, patient rock stable hemodynamic/resp, to PACU. After ~20 minutes in PACU, patient opens their eyes, smiles and asks for food.
Any problem with extubating with only criterion of regular resps, oxygenating/ventilating well with appropriate gag? Anyone else using low-dose ketamine? Appreciate any tips.
I've been trying some new things out for my run-of-the-mill cases. One of our newer attendings introduced PFK anesthesia, and as a corollary, expanded the use of low-dose (less than 50mg/case) ketamine.
As part of my new induction regimen, 1-2mg versed, ~25mg ketamine, 150-200mg propofol, sux/vec and tube/LMA. Maint with Sevo/Propofol or Sevo/N2O. Titrate narcotic based on hemodynamics (yes, bad idea, but I'm human), expected hourly requirement, etc.
End of the case is where things get interesting. We have PSVPro on our machines so it's rare not to have the patient spontaneously breathing throughout the remainder of the case. Agents off; by end of dressing <0.05 agent, N2O <10% ET and if propofol off >15-20 minutes (after running 50-100 mcg/kg/min for the case as an adjunct to spare inhalational).
Patient with a smile on their face, breathing regularyly and comfortably with appropriate gag to suction, but won't wake up. Pull tube while patient deep, patient rock stable hemodynamic/resp, to PACU. After ~20 minutes in PACU, patient opens their eyes, smiles and asks for food.
Any problem with extubating with only criterion of regular resps, oxygenating/ventilating well with appropriate gag? Anyone else using low-dose ketamine? Appreciate any tips.