Clinical Question

URgettingsleepy · Jan 10, 2006

Off the top of my head...Iso and coronary steal has been proven....In Dogs!

Iso up to one mac does not reduce cardiac output. UR

You textbooks should have loads more info...Try Miller or Barash

jwk · Jan 10, 2006

You can dilute your drugs so you can give exact dosages. But do you really want to try and give 63mg of Lidocaine, 117mg of propofol, 85.3mg of Sux and 146 mcg of fentanyl? That's the difference between theory and actual practice.

Gump · Jan 10, 2006

We actually used the weight based dosages in my peds rotation where precision is more necessary.

jwk · Jan 10, 2006

We actually used the weight based dosages in my peds rotation where precision is more necessary.

Kiddies are obviously different. The OP was noticing that everyone gives similar dosages all the time.

Gump · Jan 10, 2006

They are different, but maybe not "obviously" to a junior student.

not trying to start a pissing match, just letting the OP know that it's still important to know your weight-based dosages...

Nitecap · Jan 10, 2006

I to wondered about the cardiac steal issue with Isoflurane. Have heard diff. things from diff. CRNA's and MDA's. In Morgan and Mickal it mentions it, in big Miller it briefy mentions it then claims it that some studys showed that maybe it did, while others were inconclusive. In asking one that said he didnt buy it he claimed that he felt the Iso did prob cause some coronary dilitation however not anything more severe than PO nitro or any agent that dilated the coronarys, so he felt it wasnt that huge of a deal and still used it on some pt's with Hx. CAD. SO anyone please enlighten me as well.

Pete495 · Jan 11, 2006

I'm learning in my program that Iso is more cardiac protective than any of the other agents, and I know for a fact that is what they used the most for the heart cases where I worked prior to my venture on anesthesia education.

TraumaNurse · Jan 15, 2006

We do a lot of hearts and use Iso exclusively both on the anesthesia machine and on the perfusion machine.

Interestingly we also use pavulon which can be bad if you get the increase in heart rate. However, we attenuate that with a lot of fentanyl.

athomas91 · Jan 15, 2006

you read/learn/hear about cardiac steal - but from what i can tell it is more of a theory than a proven phenomena... please correct me if i am wrong...

however you must also consider the effects of other inhalational agents and which is more adverse... for example - des causes a transient but predictable increase in MAP by increasing both HR and SBP -esp if titrated up too quickly (which at the beginning of cases we must do to get the pt enough anesthesia to begin with)... Sevo likewise has a fairly predictable and more severe (than iso) drop in blood pressure which could be detrimental for cardiac patients...

therefore - cardiac steal which MAY happen doesn't outweigh the side effects of the other inhalation agents which nearly ALWAYS happen...

just my thoughts.

SedareDolorem · Jan 15, 2006

We do a lot of hearts and use Iso exclusively both on the anesthesia machine and on the perfusion machine.
Interestingly we also use pavulon which can be bad if you get the increase in heart rate. However, we attenuate that with a lot of fentanyl.

We also use Iso and Pavulon for our hearts in Umeå.. And lots of fentanyl. Pavulon increased heart rate isnt seen as a problem, we use it as an excuse to NOT give anticholinergics :chuckle

/Anders, Nurse Anesthesist, Umeå Sweden

London88 · Jan 16, 2006

We also use a lot of pavulon on our heart cases, however we do take into account the type of lesion we are dealing with. If we are dealing with AS then I draw up vecuronium as opposed to pavulon to avoid tachycardia. If we are dealing with MR, AR or TR then I use pavulon to keep things moving. if it is only a CABG w/outh other lesions then I use pavulon.