Is it possible to titrate paralytics?

Diprivan/Vented · Aug 4, 2004

I just thought how wonderful it would be to be able to titrate paralytics at that golden rate in which they couldn't move but could still maintain their airway. Of course, they would be sedated. Just think of all the complications and costs you would avoid by removing the need to intubate. And just think of how you'd be bringing anesthesia to a completely whole new level.

jwk · Aug 4, 2004

Almost right. They use propofol and KCl. That gets the job done and, not that they need it, but makes for a more pleasent death. How kind.

I thought it was pentothal, KCl and pavulon. What's funny is all the bleeding hearts who think, "what if it doesn't work right?". Give me a break. They START with 2000mg of pentothal (yes 2gm), then chase it with 100mg of pavulon. They'll already be dead with this. They follow that with a chaser of KCl to make the heart stops sooner than it would if they waited for the profound hypoxia due to apnea to kick in. The bleeding hearts also complain about the potential "agony" of a concentrated KCl injection - they give pentothal FIRST, and even if they didn't............so what?

Now - what was the original question for the thread? :chuckle

CRHSrn · Aug 4, 2004

what paralytic drug did harrison ford use on michelle pfifer in "what lies beneath" ? it's been a long time since i've seen it but remember the bathtub scene, where she watching the h2o rise ever so slowly ??? or was that just a "hollywood" drug ??? :rotfl:

SCSRNA · Aug 4, 2004

I thought it was pentothal, KCl and pavulon. What's funny is all the bleeding hearts who think, "what if it doesn't work right?". Give me a break. They START with 2000mg of pentothal (yes 2gm), then chase it with 100mg of pavulon. They'll already be dead with this. They follow that with a chaser of KCl to make the heart stops sooner than it would if they waited for the profound hypoxia due to apnea to kick in. The bleeding hearts also complain about the potential "agony" of a concentrated KCl injection - they give pentothal FIRST, and even if they didn't............so what?
Now - what was the original question for the thread? :chuckle

That sounds about right. My info was from a "through the grapevine" type of source. Maybe since the advent of propofol, it has become the DOC for humane death. More chance of going isoelectric w/ pentathol though. Either way, why make it easier? They got better cable than me and a gym membership while their waiting to "go to the light". Why not Clorox and a mouth gag? That also sounds about right.

georgia_aa · Aug 4, 2004

do they swipe with alcohol before they start the IV??

athomas91 · Aug 4, 2004

:rotfl: :rotfl:

bobogirl33 · Apr 2, 2011

I guess that I didn't access my search correctly. I was looking for information about titrating off Nimbex in a patient with severe ARDS. He had been on Nimbex for three days and they were wanting to titrate off the paralytic but to stop if he began to desaturate. Of course the patient is intubated with sedation and the ventilator is breathing for him. Just looking for information as to what are the things to look for when taking this medication off. I have dealt with Propofol before in similar situations in intubated patients only. Interesting reading all of your comments on this subject.

ssrhythm · Apr 9, 2011

The other day I was doing conscious sedation on a patient with morphine. He was agitated, trying to get out of bed, trying to leave the hospital, but completely confused (didn't know place or date). They had just extubated him, a bit prematurely, and he was having a hard time keeping his airway clear. I tried to educate him on coughing and deep breathing, but he was too confused. So I sedated him on morphine. His breathing dropped from 30's to mid teens, O2 sat remained in the low 90's, so I kept him on 2L NC, and nasally suctioned him, but even then, he could still move as I inserted the catheter. A few hours after I suctioned him, his temp dropped from 38.1 to around 37.2. Oh yeah, and some dumb RT said he might be retainin C02 and suggested I do an abg. His abg was fine.
That answer your question as to why?

I will return to read this entire thread when I have the time, so if my comment is beating a horse y'all have already dispatched of, sorry. I'm and RT, RN and soon to be CRNA, and this is precisely why there is such a riff between RTs and RNs and MDs etc in so many institutions. The RT had a very valid point and likely understands pulmonary pathphysiology and ventilation to a much greater degree than the majority of the practitioners in the hospital. From everything you've said, he/she certainly understands it better than you do. While I admire your outside-the-box thinking, follow up on that thinking will absolutely show that titration of paralytics on a non-itnubated patient for the sake of keeping him still is a quick path to disaster for the patient, the hospital, and for you. Now...

HUMILITY...one of the greatest personal attributes one can posses. Humility allows you to understand when you don't know something for certain. It will allow you to open your mind to the fact that others in your work environment may just understand a situation to a greater degree than you despite the fact that they may have what you consider a lesser amount of education. Humility in a team care environment is GOOD FOR THE PATIENT, and everyone on here should realize that ultimately, that is what it's all about.

misscece · Apr 14, 2011

I'm sorry I didn't read all the postings that are attached but what do you mean by "he couldn't keep his airway clear"? If his airway could not be kept clear, neither sedation - and definitely a paralytic (which I would never give without an airway) - would help. My other question is, where was the doc in all of this? Why were you and the RT trying to figure this out instead of paging the pulmonologist? And why give a respiratory depressant to someone who is having breathing difficulty? Just wondering....

NurseKitten, MSN, RN · Apr 17, 2011

Just my 2 cents - the LES opening pressure is ~20 cm H20, so I was taught as long as your PIP is significantly under that, you could use MV on LMA'ed patients. One of my favorite alternatives, personally, is to titrate PIP's on pressure support with IMV, and just augment what they're doing on their own. A little trick I learned from an RT/CRNA. Works like charm.

Darkfield · Apr 29, 2011

I'm guessing the original poster doesn't actually know what a paralytic is-it is completely inappropriate to suggest for a post-extubation pt. The fact that the nurse in question's response to confusion is to "sedate" tells me a little bit about his/her knowledge.