Sanjay Gupta: Diprivan

[DreamMachine]

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http://www.cnn.com/video/#/video/health/2009/07/29/gupta.propofol.demo.cnn?iref=videosearch

Did anyone watch this on Anderson Cooper last night?

 

[Robert Loblaw]

looks like vincent was a little nervous about being anesthetized on TV...did you see his BP (203/89!!). nice little advert for bis, too...but why was it 23? i can only wonder whether this was done for surgical reasons or for show.

 

[thegasman]

crna (or maybe aa) commits one of my favorite pet peeves, advancing the styleted tube into final position BEFORE removing stylet.

 

[Bertelman]

crna (or maybe aa) commits one of my favorite pet peeves, advancing the styleted tube into final position BEFORE removing stylet.

Just one of the reasons I *rarely* use one.

 

[doctor712]

looks like vincent was a little nervous about being anesthetized on TV...did you see his BP (203/89!!). nice little advert for bis, too...but why was it 23? i can only wonder whether this was done for surgical reasons or for show.

Probably just editing. Took a shot during the procedure and used for a pre-shot. The piece was obviously packaged so this sort of thing happens.

 

[Robert Loblaw]

Probably just editing. Took a shot during the procedure and used for a pre-shot. The piece was obviously packaged so this sort of thing happens.

let's assume the patient is anesthetized, then...why was the bis 23???

 

[Robert Loblaw]

Just one of the reasons I *rarely* use one.

you referring to the stylet or the crna?

 

[jwk]

crna (or maybe aa) commits one of my favorite pet peeves, advancing the styleted tube into final position BEFORE removing stylet.

Perhaps the anesthesiologist that was there for induction was too busy chatting with Dr. Gupta to reach over and pull it out. And as long as the stylet is not out beyond the end of the ETT, why is this really a problem anyway, whether CRNA, AA, or MD?

 

[usnavdoc]

let's assume the patient is anesthetized, then...why was the bis 23???

Im sure it is just post induction. Versed premed with Propofol induction.

 

[Bertelman]

you referring to the stylet or the crna?

nice.

 

[thegasman]

Perhaps the anesthesiologist that was there for induction was too busy chatting with Dr. Gupta to reach over and pull it out. And as long as the stylet is not out beyond the end of the ETT, why is this really a problem anyway, whether CRNA, AA, or MD?

I was trained to remove the stylet once the tip of the ett had passed the vocal cords, then advance the tube slightly farther. Even if the stylet is not protuding from the end of the tube, the rigidity of the tube/stylet combo may scrape the tracheal wall. To be honest, I don't have any evidence for this, but it has always made sense to me. And I agree with your point about the type of provider, this is irrelevent, and the anesthesiologist was otherwise distracted. However, it is possible to intubate and remove the stylet at the appropriate time without an assistant.

 

[maceo]

I was trained to remove the stylet once the tip of the ett had passed the vocal cords, then advance the tube slightly farther. Even if the stylet is not protuding from the end of the tube, the rigidity of the tube/stylet combo may scrape the tracheal wall. To be honest, I don't have any evidence for this, but it has always made sense to me. And I agree with your point about the type of provider, this is irrelevent, and the anesthesiologist was otherwise distracted. However, it is possible to intubate and remove the stylet at the appropriate time without an assistant.

i dont use a stylet......ever....

 

[Bertelman]

I was trained to remove the stylet once the tip of the ett had passed the vocal cords, then advance the tube slightly farther. Even if the stylet is not protuding from the end of the tube, the rigidity of the tube/stylet combo may scrape the tracheal wall. To be honest, I don't have any evidence for this, but it has always made sense to me. And I agree with your point about the type of provider, this is irrelevent, and the anesthesiologist was otherwise distracted. However, it is possible to intubate and remove the stylet at the appropriate time without an assistant.

When I must use a stylet, that is how it goes.

i dont use a stylet......ever....

I use it with RSI, and if I anticipate encountering some anatomic obstacles. Otherwise, I never even pull it out of the machine. Once I'm calling the shots, I'll probably drop it from my RSI routine. Either way, it's probably only once every other month that I find I needed a stylet when I didn't have one.

What my attendings tell me- "I've never regretted using a stylet".

Well, I've never regretted wearing underwear in the morning, but it's not necessary. Actually, sometimes it's nice to freeball.

 

[japhy]

ah bertelman... thanks for that. needed a good laugh!