Yeah I'm curious how this guy woke up. Was that the immediate first thing he said? Did he wake up like absolute ****?
Checking for ETCO2 is also "a basic part of the job." The "basics" are the most important things to always verify IMHO.
If you look up the CRNA, she graduated in 2005 apparently. 16 years of “experience” and still forgets to turn on anesthetic...and fails to recognize that too...wow..
I thought some previous comments alluded to that. I could be mistaken. Even so, my point still stands. If you have to supervise, you have to trust the crna to do the most basic of things like turn on the gas. If you can’t do that, there’s no point in supervising. You’d have to do the case yourself
I am NOT a fan of SUX because of the myalgias many patients experience postop for 24-72 hours. This is a common issue we tend to ignore because many of us don't follow up the next day or 48 hours later. But, IMHO, this is a real issue in terms of patient satisfaction so I always take that into account before reaching for the SUX.
Sometimes easier said than done in the care team model. In the case of this story’s provider, may have been just as likely to miss the 10 minutes of MAP’s of 35 while awaiting surgical stimulus.
Point well taken. I see it less (and we have a pretty robust system of postop checks including next day phone calls) but include it in my informed consent.
Agree that this was a case of underuse of anesthetic agent (and not an overuse of NMBA)
I’m curious about this as well. I would think an induction dose of prop would provide amnesia for at least 10 min or so.
I watched the interview with the local news group. Not to be judgemental but he appears to be...on something. If that’s a pre-existing thing, could explain Prop not lasting as long as they’d hoped.
People just need to work out instead of be couch potatoes and stuffing their faces non stop That helps with the myalgias.I am NOT a fan of SUX because of the myalgias many patients experience postop for 24-72 hours. This is a common issue we tend to ignore because many of us don't follow up the next day or 48 hours later. But, IMHO, this is a real issue in terms of patient satisfaction so I always take that into account before reaching for the SUX.
" The incidence of postoperative myalgia due to succinylcholine varies, being as high as 90% and generally thought to be approximately 50% [4, 9]. The myalgias have been described as similar to the pain or muscle soreness experienced after a significant physical activity [10]. The duration and intensity of this discomfort is highly variable."
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associationofanaesthetists-publications.onlinelibrary.wiley.com
Could be he is dealing with PTSD? And self medicating for anxiety? Why assume it’s preexisting?
The BIS is mostly trash and I don't use it routinely, but I will put it on for TIVA, pump cases, ASA 5 traumas, crash GETA sections, or any other case where the volatile has a high chance of getting below 0.7 Mac.
I've had a "former" alcoholic guy come in for an EGD. I no joke gave probably 300-400mg prop or so and the scope time was less than 5 minutes, he emerged immediately like nothing happened fully bright awake when scope came out (was also thrashing the whole time too). IV was not infiltrating, and he would need a lot just to induce some sense of unconsciousness. Maybe this guy was in the same boat? Or bad prop?
Young women need alot to go down, surprisingly. 200mg on a 50kg healthy woman is nothing for induction, even with the fent
pubs.asahq.org
Yeah eff that. This is bull****.
No, it was 13 minutes of no gas. That is a long time even for a little person like me. How long does propofol last in a 70kg person?
You must enjoy being “poor” or “solid middle class” in your country of socialized healthcare and no CRNAs.
Probably does provide amnesia for a significant amount of time. We are focusing on the “13 minutes”, the CRNA would have been ok so long as they have some prop or blasted the gas before surgical incision. They were light for a very stimulating part of surgery is the main problem here.
Absolutely!
WTF are some people learning that you or I didn’t?
The best thing about the automatic record keeping is the reduction in falsified records.
I'm a card carrying member of the Succinylcholine Haters Society. When it's actually indicated (eg RSI, laryngospasm) there's no substitute but I need a compelling reason to use it.
Hey, there are MD only practices in TX too. TX is far from being a place where socialized HC will fly
