Remifentanyl infusions

[RBA]

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Is anyone using remi infusions in a case with spontaneous respirations, such as for a knee arthroscopy? I seem to lose respiratory drive even at low doses, ie. O.125 mcg/kg/min with some diprivan.

Similarly, what dosage range do people use for remi during sedation cases.
Thanks!

 

[ProRealDoc]

Is anyone using remi infusions in a case with spontaneous respirations, such as for a knee arthroscopy? I seem to lose respiratory drive even at low doses, ie. O.125 mcg/kg/min with some diprivan.

Similarly, what dosage range do people use for remi during sedation cases.
Thanks!

😕

 

[lane]

seems a little like overkill for a knee scope... what ever happened to 100-150 mcg fentanyl?

 

[urge]

Is anyone using remi infusions in a case with spontaneous respirations, such as for a knee arthroscopy? I seem to lose respiratory drive even at low doses, ie. O.125 mcg/kg/min with some diprivan.

Similarly, what dosage range do people use for remi during sedation cases.
Thanks!

Are you a nurse?

 

[bne_12mne]

Are you a nurse?

I'm calling a Code Brown on this thread.

 

[bullard]

I've used remi at 0.05-0.08 mcg/kg/min for awake cranis. Remi is expensive, but then, so is having an awake crani.

I try to avoid remi as much as possible, but find it hard to avoid when the neurosurgeons want SSEPs, MEPs, CN7 monitoring, etc for their cranis.

So, um, remi for knee scope? WTF?

 

[ProRealDoc]

😕

Remi and propofol for knee scope? Sounds like an SRNA anesthetic plan to me.

 

[RBA]

I am in the process of playing around with remi so that when I use it on spine cases I have a little better feel for what to expect. Usually for a knee scope I'll throw a little fentanyl in with the diprivan and go from there. I've used it on intubated, ventilated patients with success. I was just curious about possible uses in spontaneous breathing situations.

 

[urge]

Sounds like an SRNA anesthetic plan to me.

No, sounds more like a crna only group.

 

[SleepIsGood]

No, sounds more like a crna only group.

well I hope Obama takes all that CRNAs money. The CRNA is definitely taking the state's with all that useless Remi cost on such a simple procedure.

 

[jetproppilot]

Is anyone using remi infusions in a case with spontaneous respirations, such as for a knee arthroscopy? I seem to lose respiratory drive even at low doses, ie. O.125 mcg/kg/min with some diprivan.

Similarly, what dosage range do people use for remi during sedation cases.
Thanks!

Remi is an expensive anesthesia gimmick thats unneeded.

 

[aredoubleyou]

Last time I called BullS..t on somebody's post, I was wrong...so I'll give RBA the benefit of the doubt.

Titrating remifentanyl to maintain spontaneous breathing is pointless, I do not think its a drug that will get a person to not move under stimulation at a dose that low. Then again I havent been using them for knee scopes.

 

[Idiopathic]

i do mine with 30cc of mepivicaine

 

[Idiopathic]

Then again I havent been using them for knee scopes.

thats because its ridiculous. either go to sleep or stay awake but dont charge someone 2 grand for an anesthetic that offers them little more than an LMA and 10 bucks worth of sevo

 

[Jay K]

Is anyone using remi infusions in a case with spontaneous respirations, such as for a knee arthroscopy? I seem to lose respiratory drive even at low doses, ie. O.125 mcg/kg/min with some diprivan.

I surmise that you're following the recommended dosage rates provided by the manufacturer's insert for sedation; These rates, especially in conjunction with propofol, are too high for the clinical utility you're looking for, as you have so plainly observed in your own cases.

On the rare occasions I run Remifol, my rate of infusion is significantly lower.

I do not run Remifol for knee scopes.

 

[Jay K]

Usually for a knee scope I'll throw a little fentanyl in with the diprivan and go from there.

Why would you mix fentanyl in with propofol? Why not simply bolus if your patient is sedated and spontaneously breathing?

 

[fakin' the funk]

O.125 mcg/kg/min with some diprivan.

I typically don't jump on the "This question is BS, the OP is a nurse!" bandwagon when it rolls around...

But, seriously, who other than old-as-f$ck ICU nurses calls it "Diprivan"?

 

[sevo85288]

Most physicians know not to use brand names to refer to medications. I hope, at least. Better yet, I use the chemical name:

2,6-diisopropylphenol

🙂

The mechanism is also more easily recalled if one can remember the chemical structure and its relation to the appropriate chemical ligands/channels.

But seriously, there should be no need for this type of anesthetic plan for routine knee arthroscopy cases. Pts do VERY well with traditional anesthetic plans.

 

[Idiopathic]

having seen my institution switch from propofol to diprivan, there is definitely a difference

 

[drccw]

I typically don't jump on the "This question is BS, the OP is a nurse!" bandwagon when it rolls around...

But, seriously, who other than old-as-f$ck ICU nurses calls it "Diprivan"?

unfortunately some of the old as F anesthesiologists in my group call drugs by their trade names. there is one guy who is horrible; everytime I take over cases from him I hear about Robinal, Zemuroron, etc...

Though I havent heard anyone ever use sublimaze.. that is really old school if they did...

 

[RabbMD]

The only one I tend to call by its trade name is zofran, because that is way shorter to write than ondansetron 🙂.

 

[Dirtball]

Remi is useful for some cases as a bolus. Reconstituted to 30-50 mcg/ml, I hand bolus via a 3cc syringe in 15-30 mcg boluses, to stop movement during a stimulating portion of a procedure that doesn't have much post op pain. ie. cystoscope insertion thru tight meatal stricture- this "MAC" case will require a few mask breaths after the remi bolus, during acromium shaving with burr during some of my shoulder scopes with ISB / LMA but no relaxant - BP may go up leading to poor visualization - options 1. ^ Gas 2. Labetolol 3. Fent. 4. Prop 5. Remi bolus . I prefer starting with remi bolus for this 5 minute BP spike. I see Pt's respond to the shaving in spite of 100% solid blocks in Pacu . Very easy to throw more narcotic at them in the OR , but I do most of my shoulders on 50 mcg Fent total. The remi bolus does it's job to dec. BP and improve visualization for a few minutes, it just may require a few squeezes on the bag. ....I don't have any infusion advice for "sedation" cases.