Rapid Opioid Detoxification during General Anesthesia

[TheLoneWolf]

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Practice anesthesia and pain. Saw a lot of substance abuse, addiction.

An advertisement I had come across during fellowship was a nearby anesthesiologist in a hospital system offering substance withdrawal under sedation. Director said he doesn't think any of the staff had ever sent patients over to this service.

Described in literature

Anesthesiology

anesthesiology.pubs.asahq.org

Ultra Rapid Detoxification (UROD) - Medical Clinical Policy Bulletins | Aetna

www.aetna.com

I think the risk far exceeds the reward in addition to the negative reinforcement experienced during withdrawal as contributing to continued abstinence. Even above study had a mortality (n-20)

Anyone had any experience with it?

 

[nimbus]

There was a lot of excitement about it years ago. Then it faded away.

Any attendings do any "Ultra-rapid detox"

Hey all A few of the attendings were talking about this the other day. Does anyone here do this? Just curious. It seems like it would need a ton of monitoring, and you'd prolly see some pretty interesting physiologic changes. I couldn't work with addicts myself, but I wouldn't mind doing a...

forums.studentdoctor.net

 

[TheLoneWolf]

There was a lot of excitement about it years ago. Then it faded away.

Any attendings do any "Ultra-rapid detox"

Hey all A few of the attendings were talking about this the other day. Does anyone here do this? Just curious. It seems like it would need a ton of monitoring, and you'd prolly see some pretty interesting physiologic changes. I couldn't work with addicts myself, but I wouldn't mind doing a...

forums.studentdoctor.net

Thanks @nimbus

 

[abolt18]

There was a lot of excitement about it years ago. Then it faded away.

Any attendings do any "Ultra-rapid detox"

Hey all A few of the attendings were talking about this the other day. Does anyone here do this? Just curious. It seems like it would need a ton of monitoring, and you'd prolly see some pretty interesting physiologic changes. I couldn't work with addicts myself, but I wouldn't mind doing a...

forums.studentdoctor.net

Well, reading that is something else!

 

[jonessoda1212]

We did this on a few kids in the PICU where I was a fellow. It was a high dose propofol infusion with rapid weaning of opiates. Monitored for prop infusion syndrome given the fact they were kids.

 

[vector2]

Saw it on an episode of ER in 1998. Didn't go that well for Clooney or the baby he tried it on

 

[siliso]

I don’t see how you’re going to reregulate and repopulate your receptors under any reasonable period of anaesthesia.

 

[Ferrismonk]

Rapid detox under anesthesia was a thing in the 80s. Sedate them, give narcan, treat withdrawal effects, wake them up, give some counseling, etc then discharge. Didn't work because addiction is more than the drug.

 

[caligas]

Terrible idea....wait, how much will they pay me?

 

[T-burglar]

Solid opioid withdrawal is anything but rapid , even cold turkey

 

[Choo]

UT Southwestern...

 

[Immigration doc]

Practice anesthesia and pain. Saw a lot of substance abuse, addiction.

An advertisement I had come across during fellowship was a nearby anesthesiologist in a hospital system offering substance withdrawal under sedation. Director said he doesn't think any of the staff had ever sent patients over to this service.

Described in literature

Anesthesiology

anesthesiology.pubs.asahq.org

Ultra Rapid Detoxification (UROD) - Medical Clinical Policy Bulletins | Aetna

www.aetna.com

I think the risk far exceeds the reward in addition to the negative reinforcement experienced during withdrawal as contributing to continued abstinence. Even above study had a mortality (n-20)

Anyone had any experience with it?

Patients are left with cravings they can’t overcome, just like after inpatient 12-step treatment. If they don’t get MAT (methadone or bup), they’ll end up dead with a needle in their arm.

 

[WholeLottaGame7]

We did this on a few kids in the PICU where I was a fellow. It was a high dose propofol infusion with rapid weaning of opiates. Monitored for prop infusion syndrome given the fact they were kids.

Some of our peds pain people have tried this on PICU patients (usually the long-term cardiac players on horse doses of sedation). Propofol for about 12-24 hours and then restart narcotic/benzos at lower dose. More to expedite the wean versus totally get them off. From what I've heard, a very mixed bag of results.

 

[coffeebythelake]

It never really worked

 

[MirrorTodd]

We did high dose ketamine on a guy who was abusing. Seemed to work as far as lowering his dose, he ended up died of a PE though and still needed opiates for pain control, so I can't say that we truly fixed him.

 

[repititionition]

We did high dose ketamine on a guy who was abusing. Seemed to work as far as lowering his dose, he ended up died of a PE though and still needed opiates for pain control, so I can't say that we truly fixed him.

dude needed post-mortem opiates for pain control? damn.

 

[MirrorTodd]

dude needed post-mortem opiates for pain control? damn.

Lol we have VERY bad surgeons.