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- Mar 12, 2005
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Heres a great case, dudes/dudettes:
One of our ortho studs had five cases yesterday, the first being an ACL repair on a 31 year old healthy dude who popped his ACL on his first slope in Vail in February.
Patient in the holding area at 0640. Gave him midazolam 4mg and did the fem/sciatic blocks (bupiv .5% with epi, 30ml each site.). Done at 0655. Into the OR at 0710. Propofol 150 mg, LMA #4, sevo at 2% until after incision, then was able to back it down to .6% for the duration of the case, which took about an hour and 45 minutes. Gas off, LMA out. He was in recovery for 30 minutes, then back to day surgery long enough to get crutches, and he was out the door. I called him at 6pm and he was just starting to have a twinge of posterior knee pain.
What are the salient parts of this case? Its funny, when you first start anesthesia you're thinking about what cool drugs you can give, and the longer you do it, you try and figure out what you can withhold. WE GAVE NO OPIODS TO ACL DUDE! None. Nodda. Keep in mind if your blocks are good, you'll have great surgical-site analgesia, so actually the LMA/sevo was probably overkill. Our next step is to do these cases with just a propofol or precedex infusion and a nasal cannula. Not having to give opiods and being able to run justa whiff of volatile agent meant this dude woke up crisp with no post-op nausea, and no pain. The key is to tell them before they leave that the blocks will last 12-24 hours, but at the first hint of pain to pop a couple percocets.
I called him at home around 6pm and he said he stopped at Subway on the way home and picked up a sandwich/chips/drink, and ate it without problems.
No opiods and minimal agent leads to minimal chance of post-op nausea, urinary retention, etc, minimal PACU stay, and a happy patient and surgeon. Become deft at regional techniques, dudes/dudettes.
One of our ortho studs had five cases yesterday, the first being an ACL repair on a 31 year old healthy dude who popped his ACL on his first slope in Vail in February.
Patient in the holding area at 0640. Gave him midazolam 4mg and did the fem/sciatic blocks (bupiv .5% with epi, 30ml each site.). Done at 0655. Into the OR at 0710. Propofol 150 mg, LMA #4, sevo at 2% until after incision, then was able to back it down to .6% for the duration of the case, which took about an hour and 45 minutes. Gas off, LMA out. He was in recovery for 30 minutes, then back to day surgery long enough to get crutches, and he was out the door. I called him at 6pm and he was just starting to have a twinge of posterior knee pain.
What are the salient parts of this case? Its funny, when you first start anesthesia you're thinking about what cool drugs you can give, and the longer you do it, you try and figure out what you can withhold. WE GAVE NO OPIODS TO ACL DUDE! None. Nodda. Keep in mind if your blocks are good, you'll have great surgical-site analgesia, so actually the LMA/sevo was probably overkill. Our next step is to do these cases with just a propofol or precedex infusion and a nasal cannula. Not having to give opiods and being able to run justa whiff of volatile agent meant this dude woke up crisp with no post-op nausea, and no pain. The key is to tell them before they leave that the blocks will last 12-24 hours, but at the first hint of pain to pop a couple percocets.
I called him at home around 6pm and he said he stopped at Subway on the way home and picked up a sandwich/chips/drink, and ate it without problems.
No opiods and minimal agent leads to minimal chance of post-op nausea, urinary retention, etc, minimal PACU stay, and a happy patient and surgeon. Become deft at regional techniques, dudes/dudettes.