Open Heart Pre-op Sedation

Specialties CRNA

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What do you use pre-op for open heart patients to gain a light sedation? We use scopolamine/10mg morphine IM. Many of the MDA's at my facility use it to attain a sort of twilight sleep from what I'm aware of. I'm wondering if this is an old method not used very much anymore? As far as sedation, we use a lot of Fentanyl in the OR, and also pavulon for muscle relax.

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We use versed and fentanyl for pre-op sedation. Up to 5mg of versed and 250 ug for fentanyl, depending on what the patient requires.

It seems like the scopolamine/ morphine combination has been around for years and is tried and true. Some may argue that scopolamine has too many potential side effects.

jim CRNA

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We use versed and fentanyl for pre-op sedation. Up to 5mg of versed and 250 ug for fentanyl, depending on what the patient requires.

It seems like the scopolamine/ morphine combination has been around for years and is tried and true. Some may argue that scopolamine has too many potential side effects.

jim CRNA

We place all of our lines in pre-op holding using small incremental doses of fent and midaz. Very rarely do we give more than 2mg and 100mcg of each. We fast-track very aggressively due to the large number of cases we do off-pump

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The scope/morphine pre-op is from back when. We used to use that routinely until we went the way of early extubation. Our folks receive nothing prior to hitting the OR. Once they are through the doors we are generous with our Versed and use that in combination with Fentanyl and Pavulon for the procedure leaving the OR with a Propofol drip hanging for sedation until they can be extubated within 4 hours. Or at least that is the goal. If we have an extremely anxious patient we may give them a little Ativan for a premed. But that's rare. Of course we decrease our dosages if we are doing the case off pump to allow for even early extubation.

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We place all of our lines in pre-op holding using small incremental doses of fent and midaz. Very rarely do we give more than 2mg and 100mcg of each. We fast-track very aggressively due to the large number of cases we do off-pump
Just curious, do you get to place/insert the swan? Or does the MDA do that?

Do you live close to Atlanta? Any spectacular job opportunities down that way?

Jim, CRNA

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Just curious, do you get to place/insert the swan? Or does the MDA do that?

Do you live close to Atlanta? Any spectacular job opportunities down that way?

Jim, CRNA

I do indeed place the Swan myself, along with any other invasive lines. The only thing that I'm not permitted to do is a sub-clavian stick. That's pretty common in the Atlanta area.

To answer your 2nd question - pretty much every hospital in this area is hiring.

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