Gotosleepy

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1. Beginner with OB epidurals

   Gotosleepy replied to SproutRN's topic in CRNA

   like said above.... the catheter issues are old... In fact, microcatheters are BIG in Europe now and are on their way through the FDA process - some of the microcatheters are 32 Gauge!!!! In fact most major OB insitutions (>10,000 deliveries/year)...

2. lets discuss extubation

   Gotosleepy replied to gaspassah's topic in CRNA

   georgia ... agreed... i like adding vioxx 25mg po prior to induction... in my practice, i feel it has made a nice improvement on limiting narcotic use...

3. Is It Possible to Feel Surgical Procedure

   Gotosleepy replied to nightingale's topic in CRNA

   interesting note: we used to do and interpret our own EEGs for SSEPs/MEPs and carotids while doing those cases.... now the neuro depts have a political stranglehold... the incidence of awareness used to be more common in cardiac cases during the 60s/...

4. lets discuss extubation

   Gotosleepy replied to gaspassah's topic in CRNA

   there is nothing wrong with high-dose narcotic techniques - especially in neonates or in cardiac or even in neuro patients.... but to use high dose fentanyl for other cases that are short (ie: tonsillectomy) is kinda pointless... you could get the sa...

5. lets discuss extubation

   Gotosleepy replied to gaspassah's topic in CRNA

   while i like the idea of high-dose narcotics - giving a patient 700mcg of fentanyl for a 20 minute case? give me a break.... while i agree the less volatile you use, the better the wake up, I find that using such high doses of fentanyl unnecessary......

6. lets discuss extubation

   Gotosleepy replied to gaspassah's topic in CRNA

   10 to 15 ug/kg??? isn't that a bit high? unless the case is going to last 4 hours or more...

7. what would you consider GENERAL anesthesia

   Gotosleepy replied to athomas91's topic in CRNA

   i like the old definition of MAC... if there is a fire during a MAC, the patient should be able to get up off the OR table and run with you to the nearest exit... 3% DES??? masking them... with a propofol infusion.... you gotta be kidding...

8. opinion on clinical practice

   Gotosleepy replied to gaspassah's topic in CRNA

   i don't think giving NDMB prior to establishing an airway is very smart at all... However, I frequently give NDMB prior to establishing an airway if I know that the patient has a recent history of intubations and was easy mask/easy intubation, or i...

9. opinion on clinical practice

   Gotosleepy replied to gaspassah's topic in CRNA

   nobody can defend giving a paralytic without ventilating... however we do it all the time for RSI.... are all RSI patients easier to intubate? and what do you do for a patient that is MH-susceptible who is going to need RSI??? and is 3 years old and ...

10. opinion on clinical practice

    Gotosleepy replied to gaspassah's topic in CRNA

    so if you can ventilate .... does that mean that you can always intubate? and if you aren't 100% positive that you can intubate, why not do all of your inubations awake?.... food for thought

11. opinion on clinical practice

    Gotosleepy replied to gaspassah's topic in CRNA

    okay.... so now you can't ventilate, patient is desaturating.... are you going to try to intubate? if so, what drugs will you give and why?

12. Is it possible to titrate paralytics?

    Gotosleepy replied to Diprivan/Vented's topic in CRNA

    gaspassah.... i see your point, and I have become far more selective in which patients i use LMAs... And no, i don't advocate the use of LMAs for c/s as they do in England.... not because i don't believe their literature (which shows it is safe), but...

13. Is it possible to titrate paralytics?

    Gotosleepy replied to Diprivan/Vented's topic in CRNA

    athomas... what is the incidence of aspiration with general anesthesia, what is the incidence of aspiration for LMAs and for ETT.... you'd be surprised by what you find...

14. Is it possible to titrate paralytics?

    Gotosleepy replied to Diprivan/Vented's topic in CRNA

    the reason i still use lmas despite my 2 silent aspirations is based on scientific grounds (ie: literature based).... just because i have 2 adverse reactions with a device doesn't mean i shouldn't use it anymore (imagine if you had 2 carotid sticks ...

15. Is it possible to titrate paralytics?

    Gotosleepy replied to Diprivan/Vented's topic in CRNA

    i agree with you jwk... they should definitely not be used indisciminately... in fact, i had two silent aspirations in no-risk factor young patients (both were okay after all), but still LMA isn't perfect. I just want point out that it is an alternat...