Tomorrow's Big Case

[cchoukal]

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34 yo M, PMHx unremarkable, presents for vasectomy. Seriously. Aren't these done wide awake under local, like, a million times a year in offices all over the world?

Prop, sux, tube?

Anyone want an a-line? Pre-induction?

 

[goodoc]

sedation

 

[Planktonmd]

34 yo M, PMHx unremarkable, presents for vasectomy. Seriously. Aren't these done wide awake under local, like, a million times a year in offices all over the world?

Prop, sux, tube?

Anyone want an a-line? Pre-induction?

You are kidding aren't you?

 

[Green912]

In my experience all you need is:
1. Old time FP Doc
2. "surgery room" in back of his small town private practice office
3. a few cc's of Lido

 

[Gaseous Clay]

You are kidding aren't you?

He'd better be kidding because he forgot the Swan and awake fiberoptic.

 

[cchoukal]

In my experience all you need is:
1. Old time FP Doc
2. "surgery room" in back of his small town private practice office
3. a few cc's of Lido

Yes, I was definitely kidding. I didn't know there was any other way than the above to do this case. I've never seen one of these scheduled in our main ORs and I'm surprised there'd be any need for us to be involved. Maybe he's got critical AS...

 

[McSnappy]

Yes, I was definitely kidding. I didn't know there was any other way than the above to do this case. I've never seen one of these scheduled in our main ORs and I'm surprised there'd be any need for us to be involved. Maybe he's got critical AS...

Or maybe he cries like a baby in front of needles... like I do😀 and.... has deep pockets full of unwanted cash.... like I don't. Probably a surgeon😉

Surely, insurance won't pay for that one.😕

 

[chemist157]

34 yo M, PMHx unremarkable, presents for vasectomy. Seriously. Aren't these done wide awake under local, like, a million times a year in offices all over the world?

Prop, sux, tube?

Anyone want an a-line? Pre-induction?

Actually, I have a friend who just had this done. He had a vasectomy but still had swimmers so they went back in and found one of the cords wasn't cut. They couldn't get to it b/c according to the doc his reflex was pulling the cord too far in to do it under local. So they did it under general anesthesia.

 

[cchoukal]

Interesting. Thanks for passing that along...

 

[jetproppilot]

Actually, I have a friend who just had this done. He had a vasectomy but still had swimmers so they went back in and found one of the cords wasn't cut. They couldn't get to it b/c according to the doc his reflex was pulling the cord too far in to do it under local. So they did it under general anesthesia.

Sounds like an excuse from the urologist for "uhhhhhh.....I missed one of the cords."

Gotta buddy-urologist thats done countless vasectomies in his office under local....they all take about 15 minutes....he's never had to take one to the OR.

....or maybe your buddy's a porn star.....

 

[Ferdie]

as a M3 on my FP rotation I got to "run the anesthesia" for a vas. For practice I started an IV to inject the midz, instead of just single shot like they usually do. Then a few CCs of lido locally.
Very complicated case...

 

[Planktonmd]

....or maybe your buddy's a porn star.....

​

 

[cchoukal]

To end the suspense, the patient no-showed anyway...

 

[pd4emergence]

If somebody is cutting on my boys I want an LMA. Screw all that local stuff, I want an LMA and I will pay out of pocket. This is a great surgery center idea. Cash only. What young healthy guy would choose anything else? "Okay sir here comes that numbing shot in your balls" vs. "we'll see you when you wake up". I think a #5 would work just fine for me.

pd4

 

[Jeff05]

GA with Nasal cannula for me.

straight prop bolus until apnea. inject local (that'll get me breathing...) run on 125mcg/kg/min.
toradol towards the end.

 

[Strength&Speed]

In my experience all you need is:
1. Old time FP Doc
2. "surgery room" in back of his small town private practice office
3. a few cc's of Lido

and then call the FP again, after the guy has another kid one year later.

 

[Strength&Speed]

Sounds like an excuse from the urologist for "uhhhhhh.....I missed one of the cords."

Gotta buddy-urologist thats done countless vasectomies in his office under local....they all take about 15 minutes....he's never had to take one to the OR.

....or maybe your buddy's a porn star.....

no, he needs that for the money shot

 

[jetproppilot]

no, he needs that for the money shot

 

[Tenesma]

i did a vasectomy during residency ... i couldn't understand why they wanted anesthesia involved... turned out patient had a tet. repair in Ghana (of all places) with some weird type of shunt, complicated by severe cor pulm. etc...
the surgeon was relieved to have anesthesia in the room - even though all i did was give the guy 2mg of Versed and the surgeon used lido...

if i had been the surgeon - i would have said to the patient : "just don't have sex"