what do you say to your patients while inducing them?

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just kidding, im very pleasant and reassuring, like "everythings going to be fine, take deep breaths, were going to take excellent care of you, etc". i always use first names.

in fact the only times all day that i actively try to be nice and sensitive are during the preop visit, induction and emergence. the rest of the time, im not so friendly.
 
"Take some nice deep courtesy breaths"

"Ok you might notice a warming sensation in your IV"

"Just let us know when you fall asleep OK?"
(usually get a chuckle or a smile after a 2 second pause)
 
pgg said:
"Pay no attention to the nice lady tying your arms to the bed ..."
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Most circulators at VA hospitals know this, but NEVER tie the arms of a former prisoner-of-war before induction. If you're at a non-VA or non-military hospital and somehow discover that your patient is a former POW, remind the circulator to wait until after induction to tie the arms.

I try to engage in light-hearted humor as I'm pushing the propofol, to make the patient laugh. Pts who are laughing as they go apneic seem to wake up better and happier.
 
"Think about a nice place you would like to go on vacation and I will try to send you" as I let them breath a little o2 and give them some midaz.

"Tray tables up and seat backs in a upright position" as I push the prop, if they complain that it burn I tell them it is a sunburn. blaz
 
trinityalumnus said:
Most circulators at VA hospitals know this, but NEVER tie the arms of a former prisoner-of-war before induction. If you're at a non-VA or non-military hospital and somehow discover that your patient is a former POW, remind the circulator to wait until after induction to tie the arms.

I try to engage in light-hearted humor as I'm pushing the propofol, to make the patient laugh. Pts who are laughing as they go apneic seem to wake up better and happier.
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🙂 I was (half) kidding about that comment. In general I try to distract them from all the people doing weird stuff around them rather than draw their attention to it.

I'm not a talkative person in general but I do generally keep a steady stream of verbiage flowing at them. "Got a couple stickers for your EKG" and "this goes on your finger" and "that cuff will squeeze your arm very tightly the first time" and "you may feels some warmth or burning in your IV as the medicine gets you off to sleep, that's normal" ...


And I'm a big fan of droperidol near wakeup for the young catecholamine charged Marines who may or may not have PTSD and who may or may not emerge swinging. I'm convinced it's the best thing since isoflurane (which we don't have any more) to mellow those guys out.
 
A buddy of mine in residency was trying to calm down a really nervous patient prior to cardiac surgery-2 mg of midazolam followed by this conversation just prior to induction on the OR table...

Doc: Okay, think of a nice relaxing image-somewhere nice like the beach or something....

Patient: (chuckling in a devious fashion....)

Doc: What are you thinking about?

Patient: My wife's sister

Midazolam-The original truth serum😀
 
siednarb said:
"Take some nice deep courtesy breaths"

"Ok you might notice a warming sensation in your IV"

"Just let us know when you fall asleep OK?"
(usually get a chuckle or a smile after a 2 second pause)
Click to expand...

I'll have to try that last sentence. :laugh:
 
trinityalumnus said:
Most circulators at VA hospitals know this, but NEVER tie the arms of a former prisoner-of-war before induction. If you're at a non-VA or non-military hospital and somehow discover that your patient is a former POW, remind the circulator to wait until after induction to tie the arms.

I try to engage in light-hearted humor as I'm pushing the propofol, to make the patient laugh. Pts who are laughing as they go apneic seem to wake up better and happier.
Click to expand...

I usually don't tie the arms until after induction anyway, but that's a good point to keep in mind. Thanks trinity.
 
pgg said:
.........And I'm a big fan of droperidol near wakeup for the young catecholamine charged Marines who may or may not have PTSD and who may or may not emerge swinging. I'm convinced it's the best thing since isoflurane (which we don't have any more) to mellow those guys out.
Click to expand...

PGG, how much do you give? I've only used droperidol for N/V, and find 0.625 mg usually does the trick, but one of my colleagues has used up to 2.5 mg for sedation.

If you find it helps with emergence I might try it also on some of my younger patients.
 
pgg said:
🙂
I'm not a talkative person in general but I do generally keep a steady stream of verbiage flowing at them. "Got a couple stickers for your EKG" and "this goes on your finger" and "that cuff will squeeze your arm very tightly the first time" and "you may feels some warmth or burning in your IV as the medicine gets you off to sleep, that's normal" ...
Click to expand...

Funny I say nearly the exact same thing. I also tell them the warmth will go away in a few seconds.
 
rsgillmd said:
PGG, how much do you give? I've only used droperidol for N/V, and find 0.625 mg usually does the trick, but one of my colleagues has used up to 2.5 mg for sedation.

If you find it helps with emergence I might try it also on some of my younger patients.
Click to expand...

I use 0.625 mg for PONV prophylaxis for most patients but give 1.25 mg to burly looking 20-something-year-old males.
 
GoodmanBrown said:
😕

Was that aimed at someone in particular? Or just a general "F--- you." to the world at large for being such a cruel place?
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Nah, that's what I think as the CRNA blabs some non-sensical crap. I almost always keep mum.
 
pgg said:
I use 0.625 mg for PONV prophylaxis for most patients but give 1.25 mg to burly looking 20-something-year-old males.
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A little anesthesia history:

Innovar = droperiodol + fentanyl mixed in an injectable form.

In the 60's and 70's it was used quite often for sedation.

clk0720c001.gif


http://bja.oxfordjournals.org/cgi/content/abstract/41/4/303
 
I usually talk to them about food and ask them to think about a juicy burger or something like that.
This is why I find vegetarian patients more challenging, there is simply no vegetarian dish that is appealing enough to be your last thought before you fall asleep!
 
The induction drivel is no where near as bad as the nonsense that seems to come out of my mouth when reassuring mums at sections.
 
rsgillmd said:
PGG, how much do you give? I've only used droperidol for N/V, and find 0.625 mg usually does the trick, but one of my colleagues has used up to 2.5 mg for sedation.

If you find it helps with emergence I might try it also on some of my younger patients.
Click to expand...

Can you say "Innovar" ?

We don't even have droperidol on formulary, but I remember using heavy doses early in my career. Too many adverse effects at high doses. Never again.
 
It's not really what I say, but the gurglings and babblings one of our particular circulating RN's likes to make as she strokes my patient's hand or hair during induction and emergence - she's been dubbed the "patient whisperer" and it drives my partners and I insane... simply insane...

How 'bout you help by putting on monitors and do a better job on that cricoid pressure instead?
 
Frank Rizzo said:
best book ever! I especially enjoy the pics in the back of the book demonstrating the different ways an OR table can be positioned... jackknife...
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Just looked it up in my program's biomed library and they have it! I may have to check it out.
 
Consigliere said:
Nah, that's what I think as the CRNA blabs some non-sensical crap. I almost always keep mum.
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Wow! You are in the room for induction? Impressive! Don't forget to sign the chart!
 
stone123 said:
Wow! You are in the room for induction? Impressive! Don't forget to sign the chart!
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What, you think this is my first rodeo cowboy? The chart is ALREADY signed before the pt is in the OR.

And yes, I am present for EVERY induction; case doesn't start until I show up. Good thing too as I need to intubate someone AT LEAST twice a week for the CRNA.
 
Consigliere said:
What, you think this is my first rodeo cowboy? The chart is ALREADY signed before the pt is in the OR.

And yes, I am present for EVERY induction; case doesn't start until I show up. Good thing too as I need to intubate someone AT LEAST twice a week for the CRNA.
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Do these patients tend to be the ones with difficult airways, or are they fairly easy tubes? It'd be hilarious if it's the latter ... and if it's the former, then they don't deserve to gain independent practice rights.
 
It is in all likley hood untrue.
 
can you send this thread to the all nursing forum please
 
Doctor4Life1769 said:
Do these patients tend to be the ones with difficult airways, or are they fairly easy tubes? It'd be hilarious if it's the latter ... and if it's the former, then they don't deserve to gain independent practice rights.
Click to expand...

They ARE somewhat challenging; point is though, they need backup. Wonder what happens in bumblef uck America where there is no backup 😱
 
simple in bumbl*uck America as you put it the awesome motor skill of intubation (I can see the need for all those years of residency and med school there) is done every day without the fanfare and stroking that you apparently require. Dude, intubation, motor skill ,no big deal, get over it, want to see a real expert? Talk to the EMT who intubated that 400 Lbs. while driving down a bumpy road.
 
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