High narcotic technique help

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I'm interested in trying high narcotic techniques in my practice. I only did a few of these in school and would like some references and/or personal suggestions. It is difficult to get information from my MD staff as they all seem to be worried about awareness and wake-up speed. This wasn't a problem in my limited experience but I'd like some additional information before trying it on my own. Any help out there?

All of which made me think of a couple of questions I've been meaning to ask about remi:

There is a recipie out there for a remi/propofol mixture that can be run as a TIVA or near TIVA. Anybody heard of this concotion?

Also, I have heard some rumors that some folks are using remi drips for endoscopy sedation. Anyone else heard of this? Seems to me to be an expensive way to "skin the cat."

Kevin McHugh

I know this is an old thread, but I have a recipe for remi/propofol, both for general TIVA and lighter anesthetics, and I thought maybe some of the other students might be able to use it, if they hadn't already. ***These calculations are based on propofol 50cc at 10mg/cc. If your concentration of propofol is different the calculations will change.***

Propofol and remi are compatible, so you can mix them in the same syringe (we use the syringe pumps, not sure what you use).

Low Dose (spontaneous repirations) - Mix 0.25mg remifentanil with 500mg propofol, run at 50mcg/kg/min (based on propofol dose)

Medium Dose (assisted respirations) - Mix 0.5mg remifentanil with 500mg propofol, run at 80-130 mcg/kg/min (based on propofol dose)

High Dose (controlled respirations) - 1-2mg remifentanil with 500mg propofol, run at 100-150 mcg/kg/min (based on propofol dose)

For example, if you had a 50kg patient, and you wanted to run Low Dose at 50mcg/kg/min, you would set your pump to infuse at 15cc/hr. Your patient would be getting:

Propofol 50 mcg/kg/min

Remifentanil 0.02 mcg/kg/min

if you had a 50kg patient, and you wanted to run Medium Dose at 80mcg/kg/min, you would set your pump to infuse at 24cc/hr. Your patient would be getting:

Propofol 80mcg/kg/min

Remifentanil 0.08 mcg/kg/min

if you had a 50kg patient, and you wanted to run High Dose at 100mcg/kg/min, you would set your pump to infuse at 30cc/hr. Your patient would be getting:

Propofol 100mcg/kg/min

Remifentanil 0.2mcg/kg/min (if you mixed 1mg remi)

or

Remifentanil 0.4mcg/kg/min (if you mixed 2mg remi)

Hope that is useful to someone....

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we use remi/propofol as well - but don't mix them - we run them in two separate IV's so that we can titrate them individually :)

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