Good day CRNA...

Ok, I'll bite:
About 2 weeks ago, I and a SRNA from NC Baptist's program, took care of a middle aged man for a re-do Laparoscopic Nissen Fundiplication and Ventral Hernia repair with mesh. (he'd had GERDs and his original lap nissen was failing) This gentleman also had fibromyalgia and was on Methadone for continuing joint and muscle pain. With his last few surgeries, he'd had incredibly difficult PACU courses b/c of inadequate pain relief. He'd received Dilaudid, Fentanyl and Versed in PACU and still did not get relief (pain scales stayed 7-10/10)
So, looking at his last records, we tried to figure out what we could do to maybe alleviate this pain for him this time. It didn't help that he was certain that we'd not be able to get him comfortable.
So, our plan for his anesthesia included large doses of Sufenta, Dilaudid at the end and Toradol. The other change we made was using Forane instead of Desflurane or Sevo. We wanted him in a "Forane fog" not wide awake at the end. So for our 4 and a half hour case, we gave 175mcgs of Sufenta. 4mg of Dilaudid and 30 of Toradol were worked in at the end. He woke up well, breathing well and we extubated him and took him to the PACU. I checked back about 3 times to see how things were going and proudly, he was resting quietly, had not needed any narcotics and everyone was very happy. We were too b/c this man really felt that there was nothing anyone could do.
I love my job for just these reasons and teaching my SRNA that you can give lots of narcotics and patients will stilll breath and wake up well and comforatable at the end. Sometimes, I feel students are afraid of giving adequate amounts of narcotics and I always make it a point to encourage their use in an anesthetic. So, I felt great after this day :hatparty:

Anyone else want to share?