About the Gasses

First of all, versed hangs around forever, so if you want your patient to wake up in a resonable time frame to be extubated when the surgery is over, this is a really bad idea. Especially in older patients, it takes forever to clear. I don't routinely even give Versed in a case that I know will be short as a pre-med unless the patient is anxious. Propofol gtts are frequently used as total anesthetics, in a technique called TIVA (total IV anesthesia). You might use this, for instance, if your patient has a history of malignant hyperthermia. Don't forget that Propofol also has its drawbacks-- I have seen it cause profound hypotension. It can also cause bradycardia, and I have seen people develop rashes after induction from histamine release.

Halothane isn't used much anymore, and will probably go by the waste side someday soon. It has some more side effects than the others and a high blood gas solubility, so it isn't eliminated very quick. the only thing keeping it on the market is its cheapness.

You can not get the anesthesia with a propofol drip that you will get with an anesthetic gas. You will understand when you get into the OR. Although, there are cases where you will not run any gas, this is generally not a good idea. It takes a lot of propofol to make somebody not move, and requires increased doses all the time. Inhalational agents above all provide excellent muscle relaxation, and this is half the point of using them. You will find you will have to run your agent at a certain % to prevent patients from moving. and as the previous poster mentioned, they provide other properties as well. In my facility, n2o is used very little anymore. the docs don't like it, and my limited experience with it hasn't made me want to use it a lot.

The old addage that versed hangs around a long time is a confusing one. I tend to think the dose is more individualized. Had a patient who got about 8mg of versed the other day and was still awake during a MAC case, and she had a cardiac history, nor was she very large, or a drinker. had to give her propofol to keep her down. most of our patients get 2mg preop, and this is just enough to keep them happy. I haven't found that I've had trouble waking some of them up. Personally, right now, I don't think versed hangs around as much as the books say it does, but that is just in my limited experience.

The clinical circumstanes are not straight forward at all in my opinion. Every patient is different, and there is always one thing you should do with one patient, that you shouldn't do with another. for instance, you wouldn't mix lidocaine w/ propofol on a cardiversion, since it is an antiarrhymic also. but we mix the lido with the diprivan on almost everyone to prevent burning. although, in another thread, it says not to do this, it is a pretty common practice you will find.