Propofol TIVA Results in Shorter Pacu Stays for Outpatient Shoulder Arthroscopy

[DocMcCoy]

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Did anybody else see this. No offense but ortho bros need to stay in their lane. I don’t think TIVA means what they think it means. Of course block and MAC are going to result in a phase 1 time of zero, it’s been done. I’ll do you one better and skip the MAC.

https://www.anesthesiologynews.com/Clinical-Anesthesiology/Article/07-24/Propofol-TIVA-Results-in-Shorter-PACU-Stay-for-Outpatient-Shoulder-Arthroscopy/74188

 

[NICMAN]

For the surgeons who “require” intubation for shoulder scopes I extubate after the sling is on. For those who are ok with block-deep sedation I have them talking as we put the sling on. So my block-sedations definitely have shorter PACU stays. I have also done a half dozen completely awake-block (for certain health-care professionals/physicians who I know well enough to trust). They basically stay in the PACU just long enough to get dressed, instructions and their 3 vitals. They have the shortest PACU stays. But it only works with really good surgeons who use low arthroscopy pressures and who “color within the lines” of the block.

 

[Arch Guillotti]

For the surgeons who “require” intubation for shoulder scopes I extubate after the sling is on. For those who are ok with block-deep sedation I have them talking as we put the sling on. So my block-sedations definitely have shorter PACU stays. I have also done a half dozen completely awake-block (for certain health-care professionals/physicians who I know well enough to trust). They basically stay in the PACU just long enough to get dressed, instructions and their 3 vitals. They have the shortest PACU stays. But it only works with really good surgeons who use low arthroscopy pressures and who “color within the lines” of the block.

Why do they go to PACU at all?

 

[NICMAN]

PACU needs their three vitals and 30 minutes. I think they are just being prudent watching for any delayed reactions to surgery…

 

[DocMcCoy]

I'm more concerned that this was an ortho led project published in JBJS. Can't wait for my 2+ hour scope with a 6in open bicep tenodesis incision surgeon asking me why I can't just "TIVA" them.

 

[ans2021]

Saw it. Saw it was a bogus study and continued on with my day planning to continue to do what I do.

 

[psychbender]

Why do they go to PACU at all?

I had an arthroscopy awake like that, went to the PACU by force of habit, then to phase 2 after one set of vitals.

 

[coffeebythelake]

Ortho bros think they unlocked some anesthesia secret sauce but really just showed how pathetically ignorant they are about anesthesia

 

[coffeebythelake]

Anesthesiology News is a rag.
Made for dummies.

 

[GassYous]

Saw a case in residency where they were doing a sitting scope mac/block and the patient starts retching and vomiting and I was like nope not doing that

 

[pgg]

Saw a case in residency where they were doing a sitting scope mac/block and the patient starts retching and vomiting and I was like nope not doing that

Yeah it's possible to make it work and do shoulders with blocks and sedation but you need a motivated patient, a motivated surgeon, and a motivated anesthesiologist. And honestly I think 90% of the time I'd be looking at 0 for 3 here. Just nowhere near enough juice for the squeeze.

 

[Maz777]

Beach chair GAs with natural airways? No effing thanks. People try to get too cute just to say they do things differently (and make themselves feel special). All of us can GETA these patients and have them wide awake as the drapes come down.

 

[UscGhost]

Yeah it's possible to make it work and do shoulders with blocks and sedation but you need a motivated patient, a motivated surgeon, and a motivated anesthesiologist. And honestly I think 90% of the time I'd be looking at 0 for 3 here. Just nowhere near enough juice for the squeeze.

1000%

 

[GassYous]

Beach chair GAs with natural airways? No effing thanks. People try to get too cute just to say they do things differently (and make themselves feel special). All of us can GETA these patients and have them wide awake as the drapes come down.

True but I do lateral and sitting shoulders with lmas without any issues

 

[PpfSuxTube]

Old news. And even mediocre news. Plenty of shoulders scopes have 0 pacu times with a decent block.


Some are very painful even with block if they stab em in the back