[gaspassah]

no flame intended and i'm no expert, but i think this would get you into trouble

Would love to be able perform some titration of paralytic trials on some pts while on CPAP, but unable to at this point in time.

[jwk]

Originally Posted by Diprivan/Vented

Fentanyl is good for the longer procedures, especially because it's cheap, but IMHO nothing beats diprivan just before extubation after CPAP trial.

Am I missing something? Diprivan prior to extubation? Makes little sense to me. Someone enlighten me.

Originally Posted by Diprivan/Vented

Would love to be able perform some titration of paralytic trials on some pts while on CPAP, but unable to at this point in time.

I think this was discussed on another thread with an overall negative opinion.

[gaspassah]

dip vent, although we did discuss this in an earlier thread there are some questions i would like to ask.
1. why do you want to titrate a paralytic on a patient you want to extubate.
2. as far as muscle paralysis. what muscles are you looking to paralyze specifically.
3. what is to be gained from partial paralysis that cannot be gained through sedation.

now as i remember muscles are paralyzed in this order:
1. eyes
2. extremeties
3. chest (intercostals from the strap muscles downward)
4. abd muscles
5. the diaphram
they recover in the reverse order.
i'm just not following your rationale.
d

[Diprivan/Vented]

Let me just preface this with the fact that this is all theory. I wouldn't ever do this nor do I have it within my scope of practice to do this. Also, I think I am using the word "paralytic" more liberally than you guys are. In my view, a paralytic is anything that would stop a pt from reponding to a nauseous stimuli. So in my view, a sedative at the right dosage could be a paralytic, but then you have to worry about impaired respirations. The only thing I've noticed with sedatives and analgesics is that they affect the conscious part of the brain and depress the respiratory system while still leaving reflexes in tact. So you could have a pt breathing in the low teens, O2 sat in the mid 90's, and still able to respond to simple nauseous stimuli, such tickling his nose and him still able to wiggle his head away. You can't really perform any complex procedure with these reflexes still intact. If you guys know of any meds that would nullify these reflexes while still keeping intact the respiratory drive, I'd love to hear it. Then we wouldn't need to discuss extubation because we wouldn't need to intubate in the first place. I know gaspassah mentioned ketamine. I don't have any experience with ketamine.

[jwk]

Originally Posted by Diprivan/Vented

Let me just preface this with the fact that this is all theory. I wouldn't ever do this nor do I have it within my scope of practice to do this. Also, I think I am using the word "paralytic" more liberally than you guys are. In my view, a paralytic is anything that would stop a pt from reponding to a nauseous stimuli. So in my view, a sedative at the right dosage could be a paralytic, but then you have to worry about impaired respirations. The only thing I've noticed with sedatives and analgesics is that they affect the conscious part of the brain and depress the respiratory system while still leaving reflexes in tact. So you could have a pt breathing in the low teens, O2 sat in the mid 90's, and still able to respond to simple nauseous stimuli, such tickling his nose and him still able to wiggle his head away. You can't really perform any complex procedure with these reflexes still intact. If you guys know of any meds that would nullify these reflexes while still keeping intact the respiratory drive, I'd love to hear it. Then we wouldn't need to discuss extubation because we wouldn't need to intubate in the first place. I know gaspassah mentioned ketamine. I don't have any experience with ketamine.

What you're describing is called ANESTHESIA.

[Passin' Gas]

[quote=Diprivan/Vented]
simple nauseous stimuli, such tickling his nose and him still able to wiggle his head away

Noxious stimuli?