High narcotic technique

kmchugh · Oct 18, 2002

Tenesma et al

Did an off pump heart yesterday, using remi with about half MAC forane. This was really the first time I had used remi for an off pump heart, and was greatly impressed. Anesthesia was very smooth, and the patient seemed to tolerate cardiac manipulations quite well. Of course, this is only one heart, so he may have just been an exception, but it did work quite well. I also left the remi on while taking the patient to the SICU (a recently approved procedure at this hospital). There was about enough left for an hour's worth of the drip on arrival, and told the nurse to leave it on till it ran out. Also explained to the nurse the short acting nature of the med, so to give a longer acting narcotic (morphine, etc) about 10-15 minutes prior to the remi running out. Planning on visiting the patient this morning to see how all went.

Yes, it did give me another gtt to keep track of (was also running dopamine, ntg, amicar, and an insulin gtt), but it seemed worth it. The patient was NIDDM, so turned off the insulin about 45 min prior to the end of the case, and kept track of blood sugar. He did well.

On another note, the surgeon yesterday was a bit short at the idea of running renal dose dopamine. There seems to be some controversy here on that. Some physicians and CRNA's swear it works, others say it doesn't. Personnally, I think it does, with most patients. Any thoughts?

Anyone else using remi for hearts?

Kevin McHugh