muscle relaxants

yoga crna · May 6, 2006

I used sux drips for years and years. The main problem was the phase 2 block as was previously noted. Also, some anesthetists used the drip to cover up inadequate anesthesia. If the patient moved, they would just increase the drip, instead of ascertaining the problem and giving the right drug.

Some of the old surgeons loved to see that red labeled bottle hanging on the IV pole and fussed that patient wasn't relaxed if they didn't see that drip running. There were many cases where I just plugged the needle in the towel of the armboard and let it drip away and the surgeon would say, "see that's better".

jwk · May 6, 2006

I don't even know if sux powder is still available. The mix was 1 gram in 500cc at our place (2mg/cc). Of course back in the old days, that bag might last a day or two or three since we would use it on several patients.

You could still do the same thing now without the powder - add a 10cc (200mg) vial to 100cc and have just a smidgeon less than 2mg/cc.

I haven't done this in probably 20 years, ever since vec and atracurium were released. We never used a twitch monitor back then - you just kind of got a feel for it. I don't remember how much total we gave, but I'm guessing usually in the 200-300mg range, but again, it's been 20+ years or so. Better too little than too much. If they started breathing, we increased the rate a little. You want to avoid that damn phase II block, because then you're screwed.

And yoga - you're right - a little misdirection can go a long way - just acting like you're doing something when the surgeon says the patient's getting tight often works wonders.

rayman · May 6, 2006

Yoga, deepz, jwk and all the other old timers, it's just pretty damn impressive listening to you guys. All the different monitors and such we have today are great and have led to even safer administration of anesthetic, but just the intuitive administration--for lack of a better phrase--of anesthesia that you guys did back in the day.....wow! You can tell the you guys have such an innate grasp of it all. Hopefully someday I'll be able to stand on the shoulders of anesthetists like you and be half as good. Thanks for the knowledge and depth you guys give to the forum and anesthesia.

catcolalex · May 8, 2006

the conversation about muscle relaxants and reversl agents might change a whole lot as soon as sugamadex comes out. apparently it reverses a full 1.2 mg/kg intubating dose of roc in 2 minutes, less than waiting for sux to wear off, and no side effects up to this point in time. also works on vec and panc, but not as well as roc.

jwk · May 8, 2006

the conversation about muscle relaxants and reversl agents might change a whole lot as soon as sugamadex comes out. apparently it reverses a full 1.2 mg/kg intubating dose of roc in 2 minutes, less than waiting for sux to wear off, and no side effects up to this point in time. also works on vec and panc, but not as well as roc.

I still think sux is a great drug and will still have a place as long as rapid onset is required. Higher dose roc still is not as fast as sux.

MmacFN · May 8, 2006

I like reading about how it "used to be done".

There are severe disadvantages to becomming reliant upon technology. I taught a Hemodynamic class to a bunch of CCU nurses the other day, i was amazed that none could calculate drip rates, few knew that most drips (nitro, lido, amiod etc) go in D5W, when i had re-constitution questions involving an unusual size fluid bag with a standard dose it was sheer chaos.

All the pumps, pre mixs and dose calc pages do dull peoples ability to do these things without the tools. Im a big fan of tools, but if they stop working, break or are just not avaliable... your SOL.

I noticed the same thing with a IABP class i taught awhile back. These pumps (we use the arrow autocat) are amazing. Sadly, they are far too idiot proof. When i turned off the auto timing noone was able to time the machine. This totally show lack of understanding about what is really happening. It is upsetting in a way as many ppl are simply becomming technicians.

Good posts jwk, yoga and deepz

athomas91 · May 9, 2006

i agree the new drug will have advantages - however - like jwk stated - sux still has a faster onset...and why would you pay $$$$ for roc - then pay an unknown probably ungodly amt to reverse it when you could have just used good ole sux to begin with...?!?!?

i think the new reversal/binding agent will just allow laziness because you can give roc/vec however you want and use this to bind it - no twitch monitoring needed to make sure they are ready to reverse... although i am always for the advancement of a field....some art is being lost in the processs..

rn29306 · May 9, 2006

i agree the new drug will have advantages - however - like jwk stated - sux still has a faster onset...and why would you pay $$$$ for roc - then pay an unknown probably ungodly amt to reverse it when you could have just used good ole sux to begin with...?!?!?
i think the new reversal/binding agent will just allow laziness because you can give roc/vec however you want and use this to bind it - no twitch monitoring needed to make sure they are ready to reverse... although i am always for the advancement of a field....some art is being lost in the processs..

I agree athomas91, technology makes things easy, but the art is lost.

Same goes for des. Des can make anyone look like a pro, not really much timing involved, just turn it on and off. Unfortunately, same goes for the Glidescope. Non anesthesia providers could probably use the thing being utilized after watching a couple of intubations.

I'm not really bagging on technology, just observing some non-anesthesia people's attitudes.