i was curious - do any of you use this mix for MAC cases?
i have been to a clinical site that does and another that completely disapproves - and many of my cohorts in school have found the same to be true...
reasons i have been told it is useful: not as much hypotension, less resp depression
reasons i have been told is bad idea: adrenal cortical suppression (significant), N/V due to amidate
i was under the impression that the adrenal suppression was more dose related - ??? when doing this i was using 10 mg of amidate in 200mg propofol - or pushing 2mg of amidate here and there and 10-30mg of propofol here and there (GI lab)...
I had an interesting case recently. Pt was an ASA IV with intractible pain from CBD stones, and this was really a quality of life issue. We did a MAC for ERCP with much trepidation and fear d/t cardiomyopathy, poor EF, and you name it.... I pretreated with Zofran 4 mg. For sedation, I used 2mg Versed and Fentanyl and titrated Amidate in 2mg increments for the case. I did give a touch of lidocaine IV just prior to beginning the amidate. He received a total of 8mg, tolerated it well, no nausea, great sedation for procedure and maintained his own airway. I was leary, but it worked...well.
emergence artist
6 Posts
I had an interesting case recently. Pt was an ASA IV with intractible pain from CBD stones, and this was really a quality of life issue. We did a MAC for ERCP with much trepidation and fear d/t cardiomyopathy, poor EF, and you name it.... I pretreated with Zofran 4 mg. For sedation, I used 2mg Versed and Fentanyl and titrated Amidate in 2mg increments for the case. I did give a touch of lidocaine IV just prior to beginning the amidate. He received a total of 8mg, tolerated it well, no nausea, great sedation for procedure and maintained his own airway. I was leary, but it worked...well.