10+ Year Member
- Dec 13, 2005
- Attending Physician
Anybody do this? I have heard of someone filling up a 50ml NS bag up with the induction agents and dripping it in as they apply monitors and preox.
One syringe with all your induction meds, sure. But I can't for the life of me figure out why anyone would deliberately start a drip-drip-drip induction before the patient has monitors on. What's the benefit?
This is like populating an island with cloned dinosaurs, lots of talk about if it could be done but not whether it should be done.
yeah i usually scope out the IV landscape in these patients because it is my one worry, also, i can get someone induced with volatile & nitrous pretty quickly if i have to. always important to remember this.I know it's rare for the IV to blow between meds. But it does happen...
I don't understand 3mg/kg of propofol in adult patients. It seems like 50% too much and it would probably require a second syringe/bottle for most adults.Here is a good one your patients will appreciate. It will get you fast intubating conditions in the longer upper extremity cases that need to be tubed.
Since the BP cuff will go on the same side as the IV in these cases, try this one out and see if you like it.
1) Depending on the patient, start with 1-2mg of dilaudid in pre-op (depending on the patient).
2) After the patient is in the room, put on the BP cuff as soon as possible. Cycle it and while it's up, dump in 5 ccs of 2% lido while pre-oxygenating. This will keep the Lido in the distal upper extremity giving those veins a mini bier block. (ROC and PROPY both can hurt! )
3) Once the BP cuff takes it's measurement and blood flow is reestablished, hit 'em with some prop (1.5-3 mg/kg) and roc (1.5 mg/kg) +/- some alfenta all in the same syringe. By this point, dilaudid will be kicking in and alfenta will help smooth things out as the tube goes in. Hemodynamics stay pretty solid and the patients go to sleep very peacefully with minimal to no vein irritation. Intubating conditions are lightning fast.
Of course, every patient needs to be treated with respect and this formula is not for everyone... especially the oldies. In the healthy 30-50 y/o, it works like magic.