Lap Chole and Narcotics

[bwt02]

Just wondering how much narcotic, specifically fent. you give for a typical Lap Chole. I have experienced 3 cases this week were I had to give a very small dose of naloxone to get the patient back breathing. (ET Sevo 0.1, fully reversed, ETCO2 45- 50 and still not breathing.) I typically have the agent off at the time the trocars are removed from the abdomen.

[snakebitten]

sissies

[SedareDolorem]

And your ephedrine/neo/vasopressor of choice!

Well, not necessary! If you keep opiate levels low, you´ll use more gas to keep intraop stress levels down. If you in that situation give fentanyl you´ll surely have a blood pressure drop. But the drop in BT isnt a direct farmacological effect of fentanyl, its the fentanyl that removes the "pain" that kept the patients BT up earlier.

If you start with a stiff dose (the dosages that Snakebite propose) with opiate at induction time, and afterwards just add gas - youll find yourself using much less agent. And you also get a very circulatory stable patient too. Circulary stable, but hard to get to breathe sufficiently afterwards in a reliable way.

The first time I emtied a full 20 ml syringe of fentanyl into a patient, I admit it felt adventurous.. I was used to tosages of 5-10 ml per case. (0.05mg/ml)

High dosages of opiates has distict advantages, especially with circulatory challenged patients. It has its distinct drawbacks too - respiratory depression.

/Anders, Nurse Anesthesist, Sweden

[jwk]

sissies

15cc of Fentanyl for a 20-30 minute case is probably excessive to most people. I have a hard time believing they're breathing adequately in that short period of time without narcan. But hey, if it works for you, fine, but I'll pass.