Nausea and Vomiting - page 3
Need some opinions here, please. Practicing CRNAs: Which antiemetics do you use ? In combination with? And which ones for which cases? Which cases do you also suggest using Toradol for longer... Read More
Feb 12, '03VAMedic;
I have a total thyroidectomy tomorrow for one of my cases. Reinforced tube, etc. Will look up all the details tonight, make up a couple of careplans and plan of actions. (also 2 lap chole-s and an inguinal hernia to round out the day). I should be pretty tired when the day is done. Will definately be trying some of the great ideas I have gathered from the last couple of days here.
Feb 12, '03VaMedic - I am an MDA
For Qwigley... are they doing RLN monitoring for your thyroid tomorrow? i like to run my patients relatively light, but w/ RLN things have to always become heavy.
For my thyroids I start a remifentanyl drip just as they start closing - at about .15 mcg/kg/min, that way I can have my volatile off... I turn the remi down slowly - I keep them on the vent at about 2-4 breaths per minute... and as soon as they overbreath the vent, i turn the vent off, drop the remi by half and then call out their name... they open their eyes slowly, I tell them that i will suction them, suction, suction, then i pull out the tube and turn off the remi... every once in a while they need some mask ventilation for a minute (at most)... they wake up without ever bucking, without ever putting a strain on the stitches. this remi technique works great for hernias too... the surgeons love it!
and i hardly never give narcotics for thyroids - the pain is minimal. the purpose for the remi is stop them from feeling the tube.
Feb 12, '03Tenesma
I would have been lucky to have you. The MDA I had seemed annoyed because the student missed an easy IV on me twice and he ended up having to do it due to them being overloaded with cases. Gave me the feeling that he did not really care about anything and definatly was not reassuring knowing that he was about to put me under. I had surgery before and had told him that I had gotten sick right after it, he gave me the little uhuh with the whatever look. I know we all get tired, but the positive game face needs to be put on in front of the patients. Glad to see you posting here though, it is much more reassuring.
Feb 13, '03Tenessma; RLN monitoring?? I didn't see that, and I'm not sure what it is. (We may call it something else??) I used a reinforced 7.0 cuffed oral, anectine, pentathal (allergy to eggs), lidocaine, roc and a whopping 10 ml of fentanyl. Oh, and 4 mg MSO4! Sevo at 1.5, N20 1, O2 1, SIMV rate of 8. Wt 102. kg female. And still had to treat hypertension. She ate thru this stuff. The remi drip would have made my life MUCH better! The case took a long time and in the middle of it, my preceptor changed (total of 3 preceptors today). Everything Iwas told to do and for their specific reasons became completely wrong. Rather annoying case today. At least it was the last of the day. I can add that the 2 lap chole and L inguinal hernia went well!
Feb 14, '03Reccurent laryngeal nerve monitoring. A few surgeons do it and some others don't want paralytics to allow them to stimulate the nerve easily. Most of the thyroidectomies have not used anything special but the surgeon's skill to locate the nerves.
Feb 16, '03We didn't use this technique, but I was asked to check the cords for movement before extubation. I don't know who uses RLN around here yet.
Feb 20, '03Post op visit:
This poor patient was still nauseated and vomiting at 1200, at the time I got a chance to see her. The floor RN gave her the prescibed Reglan for N/V, but didn't heed warnings and pushed it fast. The woman kept getting the hiccups which in turn cuased even more N/V. (common side effect of Reglan; if pushed too fast anything from hiccups to dysrhythmias).