A vial of remi is about $52. A 250mcg vial of fentanyl - about $2. Run it as an infusion? Hey, it's easy to spend other people's money. (That's the biggest problem with our government too. Doesn't mean it's prudent or right.)
Yes (and the rest of your post). The problem is the thoughtless "cookie-cutter" dogmatic approach to anesthesia that infiltrates certain practices and people stop thinking about what they're doing, what could be better/cheaper/more efficient, and what makes the most sense perioperatively. Me? I'm generally a "less is more" kind of guy. And my patients seem to have fewer "issues" post-operatively. I spend less money overall. I rarely need to leave people intubated going to the PACU. I don't believe every latest B.S. study that says everything I've done for the past 11 years is wrong. It's really hard to quantify a thinking-man's approach. And most people don't care. I happen to care.
In fact even yesterday that neurosurgeon told me - and I quote - "thank God it's you doing this case and not Dr. 'Pink'" (who I turned a neuromonitoring case over to with the same surgeon last week only to have it completely f*cked-up by "Dr. Pink" I find out the next day). I know how to use all the drugs in the drawer. Doesn't mean I have to. An elegant anesthetic is often one that has as few variables as possible and makes complete sense in the broader peri-operative context.
In my mind remi is a **** drug with little clinical value. Just like the BiS monitor. Beware the sales/marketing people and their agendas. That's all. You don't need to use remi. For anything.
in red - which vial of remi costs that much (1,2 or 5mg)? regardless, comparing ug/dollar of remi vs fentanyl is a pinhole view - equianalgesic doses have very different uses and durations of actions. i've previously agreed that long infusions of remi are a bad idea. if you are going to make a cost comparison you need to look at the "broader perioperative context". ie specific patient/case uses, pacu time, oxygen needs, OR time, complication rates etc. not just your anecdotes but statistics.
you don't have remi in your drawer - you said your hospital doesn't carry it.
i have never in 10 years seen a remifentanil ad/marketing ploy/or rep in any of my workplaces that i can remember. (as opposed to the many BIS pushers i have met over the years (although they have thankfully faded away...))
your statement in blue is awesome. the stuff between the red and blue seems to be a bit of a ramble.
however, comparing remifentanil to the BIS is silly.
we'll just have to disagree there. it's the perfect drug for a very few situations. i agree completely with urzuz - different strokes, man. if fentanyl works for you, more power to you. 99% of the time fentanyl or the old fashioned works great, but 1% of the time there's a better drug, a better way. try it, you'll like it.
why????
