NMBD Reversal

[DrDre']

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Cant remember if there has been a thread on this. Why search?


What do u PP gurus do with reversal?

Full reversal until X amt of time has passed?

Do u do "defensive" reversal even after many hours?

Do have a magic neo:glyco ratio to decrease tachy ( I use 5:0.7 when I do full dose)

Like to hear from the real world on this. Noyac had some good thoughts on this on another thread.

dre'

 

[dhb]

http://forums.studentdoctor.net/showthread.php?t=407984

 

[DrDre']

hx man. Even read it the first time 🙂

http://forums.studentdoctor.net/showthread.php?t=407984

 

[DrDre']

that would be a thanks not a history. my keyboard is dying!

hx man. Even read it the first time 🙂

 

[coprolalia]

I think we overdo it with the glyco in adults. The 1mg neo to 0.2 glyco stuff is the right thing to do in kids to pre-empt the tachycardia. After all, they are one big vagus nerve. One attending I work with is 1mg/0.1 glyco, so "full" reversal would be 5/0.5. Have done it. No prpblems (i.e. bradycardia) yet.

If you read "Secrets" (out of Univ of Colorado), they inherently recommend reversing everyone to minimize any "occult" residual paralysis. But, I've done cases where you give an intubating dose of Roc up front and then they breathe on their own for the next four hours. Seems a little ridiculous to reverse them at the end, especially with the controversy about neostigmine potentially adding to PONV.

This is an important discussion that we could re-debate here. I hope there's more interest in this thread.

-copro