Stock succinylcholine and my cart at endoscopy center?

[risnwb]

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Is stocking roc / sugammadex adequate for out-patient endoscopy center? It will save money both in supplies and in MH training, but is it safe?


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[Chloroform4Life]

Can low dose rocuronium be used to treat laryngospasm? If you have to use intubating dose of rocuronium to treat laryngospasm, then reverse it with a big dose of sugammadex, are you still saving money?

 

[Robotic Wis-Hipple]

Is stocking roc / sugammadex adequate for out-patient endoscopy center? It will save money both in supplies and in MH training, but is it safe?

The new dantrolene formulation won't expire as quickly as the old formulation, though I'm not sure the cost. I also recall not having sux was part of what got Joan Rivers killed, so it's happened once in a high profile scenario so I'd imagine if you didn't have it there'd be legal risk. I admit to knowing nothing of the cost/benefit analysis however.

Edited as I initially thought this was an ASC that would also be administering volatiles

 

[Ignatius J]

The new dantrolene formulation won't expire as quickly as the old formulation, though I'm not sure the cost. I also recall not having sux was part of what got Joan Rivers killed, so it's happened once in a high profile scenario so I'd imagine if you didn't have it there'd be legal risk. I admit to knowing nothing of the cost/benefit analysis however.

Edited as I initially thought this was an ASC that would also be administering volatiles

I would be interested to know about IM roc pharmacology. I would just rather sux.

 

[skypilot]

Is stocking roc / sugammadex adequate for out-patient endoscopy center? It will save money both in supplies and in MH training, but is it safe?


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There is no substitute for sux for a stat intubation. Having said that, I know that this is a perennial question for outpatient centers with sedation, (be honest sometimes it goes beyond sedation) non general anesthesia. But ask yourself, as an Anesthesiologist do you want to be caught with a failing airway, no sux, no lma, and no endotracheal tube and no 10 blade to cut the cricothyroid? If the answer is no I don't want to be in that position then get the meds and the equipment you need.

 

[pjl]

There is no substitute for sux for a stat intubation. Having said that, I know that this is a perennial question for outpatient centers with sedation, (be honest sometimes it goes beyond sedation) non general anesthesia. But ask yourself, as an Anesthesiologist do you want to be caught with a failing airway, no sux, no lma, and no endotracheal tube and no 10 blade to cut the cricothyroid? If the answer is no I don't want to be in that position then get the meds and the equipment you need.

Anyone want to guess the cost of all these things combined? Both a startup and restocking fee once they expire?

If nobody knows I will try to look it up when I have some down time, but I would be willing to bet it is ~what you earn from one or two well insured outpatient scopes, and definitely less than the facility earns for the same.


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[BLADEMDA]

Just keep bottle of sux in your pocket at these centers which refuse to carry them. If you ever need it then it will be on hand. I can tell you the odds of seeing MH from using sux and sux alone just once or twice in your career at a Gi center is 10 times less than being struck by lighting on your way to an AANA PAC meeting

 

[aneftp]

The new dantrolene formulation won't expire as quickly as the old formulation, though I'm not sure the cost. I also recall not having sux was part of what got Joan Rivers killed, so it's happened once in a high profile scenario so I'd imagine if you didn't have it there'd be legal risk. I admit to knowing nothing of the cost/benefit analysis however.

Edited as I initially thought this was an ASC that would also be administering volatiles

Yup.

I don't know why the stupid ASA (or even the AANA) didn't make more of the story about not having sux at these GI centers.

It would have been a slam dunk TMZ type of story "GI center kills Joan rivers cause they favor profit over safety!!!" Cause they too cheap to pay $3000 a year for MH cart so they don't have to carry sux.

 

[ranvier]

Having to bring outside meds in order to be fully prepared feels like a murky practice. It bothers me that I have to stash a few things in my bag in order to provide the best care. Sux, ephedrine, glyco, neostigmine.....during the drug shortages, some centers would keep a vial of each in an administrators office. I definitely can get by without them but I shoukdn't have to in order to save the center a little coin much less during an emergency.

I think it illustrates where we stand in the scheme of things compared to ortho implants and hardware, da vinci robots, protein rich plasma, exparel, steak sandwich, whatever else the surgeon might want....

 

[twoliter]

The new dantrolene formulation won't expire as quickly as the old formulation, though I'm not sure the cost. I also recall not having sux was part of what got Joan Rivers killed, so it's happened once in a high profile scenario so I'd imagine if you didn't have it there'd be legal risk. I admit to knowing nothing of the cost/benefit analysis however.

Edited as I initially thought this was an ASC that would also be administering volatiles

I'm pretty sure the newer formulation has a shorter shelf-life, 2-years vs. 3 years, compared to the older formulation.

 

[Robotic Wis-Hipple]

I'm pretty sure the newer formulation has a shorter shelf-life, 2-years vs. 3 years, compared to the older formulation.

You're right. Hmm, that surprises me.

 

[criticalelement]

Having to bring outside meds in order to be fully prepared feels like a murky practice. It bothers me that I have to stash a few things in my bag in order to provide the best care. Sux, ephedrine, glyco, neostigmine.....during the drug shortages, some centers would keep a vial of each in an administrators office. I definitely can get by without them but I shoukdn't have to in order to save the center a little coin much less during an emergency.

I think it illustrates where we stand in the scheme of things compared to ortho implants and hardware, da vinci robots, protein rich plasma, exparel, steak sandwich, whatever else the surgeon might want....

8 years ago i was working at an endo center on a part time basis. The owner of the management co. told me that sux was not available because of the dantrolene being too expensive. I stayed there 3 months. THe owner came to visit us at the center. I re iterated my concerns about not having sux available. He didnt do anything about it, so I walked after three months. Not worth it. They were bringing in questionable patients too.