Gotosleepy

Gotosleepy

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All Content by Gotosleepy

  1. Beginner with OB epidurals

    Gotosleepy replied to SproutRN's topic in Certified Registered Nurse Anesthetist, CRNA

    like said above.... the catheter issues are old... In fact, microcatheters are BIG in Europe now and are on their way through the FDA process - some of the microcatheters are 32 Gauge!!!! In fact most...

  2. lets discuss extubation

    Gotosleepy replied to gaspassah's topic in Certified Registered Nurse Anesthetist, CRNA

    georgia ... agreed... i like adding vioxx 25mg po prior to induction... in my practice, i feel it has made a nice improvement on limiting narcotic

  3. Is It Possible to Feel Surgical Procedure

    Gotosleepy replied to nightingale's topic in Certified Registered Nurse Anesthetist, CRNA

    interesting note: we used to do and interpret our own EEGs for SSEPs/MEPs and carotids while doing those cases.... now the neuro depts have a political stranglehold... the incidence of awareness used...

  4. lets discuss extubation

    Gotosleepy replied to gaspassah's topic in Certified Registered Nurse Anesthetist, CRNA

    there is nothing wrong with high-dose narcotic techniques - especially in neonates or in cardiac or even in neuro patients.... but to use high dose fentanyl for other cases that are short (ie:...

  5. lets discuss extubation

    Gotosleepy replied to gaspassah's topic in Certified Registered Nurse Anesthetist, CRNA

    while i like the idea of high-dose narcotics - giving a patient 700mcg of fentanyl for a 20 minute case? give me a break.... while i agree the less volatile you use, the better the wake up, I find...

  6. lets discuss extubation

    Gotosleepy replied to gaspassah's topic in Certified Registered Nurse Anesthetist, CRNA

    10 to 15 ug/kg??? isn't that a bit high? unless the case is going to last 4 hours or

  7. what would you consider GENERAL anesthesia

    Gotosleepy replied to athomas91's topic in Certified Registered Nurse Anesthetist, CRNA

    i like the old definition of MAC... if there is a fire during a MAC, the patient should be able to get up off the OR table and run with you to the nearest exit... 3% DES??? masking them... with a...

  8. opinion on clinical practice

    Gotosleepy replied to gaspassah's topic in Certified Registered Nurse Anesthetist, CRNA

    i don't think giving NDMB prior to establishing an airway is very smart at all... However, I frequently give NDMB prior to establishing an airway if I know that the patient has a recent history of...

  9. opinion on clinical practice

    Gotosleepy replied to gaspassah's topic in Certified Registered Nurse Anesthetist, CRNA

    nobody can defend giving a paralytic without ventilating... however we do it all the time for RSI.... are all RSI patients easier to intubate? and what do you do for a patient that is MH-susceptible...

  10. opinion on clinical practice

    Gotosleepy replied to gaspassah's topic in Certified Registered Nurse Anesthetist, CRNA

    so if you can ventilate .... does that mean that you can always intubate? and if you aren't 100% positive that you can intubate, why not do all of your inubations awake?.... food for

  11. opinion on clinical practice

    Gotosleepy replied to gaspassah's topic in Certified Registered Nurse Anesthetist, CRNA

    okay.... so now you can't ventilate, patient is desaturating.... are you going to try to intubate? if so, what drugs will you give and

  12. Is it possible to titrate paralytics?

    Gotosleepy replied to Diprivan/Vented's topic in Certified Registered Nurse Anesthetist, CRNA

    gaspassah.... i see your point, and I have become far more selective in which patients i use LMAs... And no, i don't advocate the use of LMAs for c/s as they do in England.... not because i don't...

  13. Is it possible to titrate paralytics?

    Gotosleepy replied to Diprivan/Vented's topic in Certified Registered Nurse Anesthetist, CRNA

    athomas... what is the incidence of aspiration with general anesthesia, what is the incidence of aspiration for LMAs and for ETT.... you'd be surprised by what you

  14. Is it possible to titrate paralytics?

    Gotosleepy replied to Diprivan/Vented's topic in Certified Registered Nurse Anesthetist, CRNA

    the reason i still use lmas despite my 2 silent aspirations is based on scientific grounds (ie: literature based).... just because i have 2 adverse reactions with a device doesn't mean i shouldn't...

  15. Is it possible to titrate paralytics?

    Gotosleepy replied to Diprivan/Vented's topic in Certified Registered Nurse Anesthetist, CRNA

    i agree with you jwk... they should definitely not be used indisciminately... in fact, i had two silent aspirations in no-risk factor young patients (both were okay after all), but still LMA isn't...

  16. Is it possible to titrate paralytics?

    Gotosleepy replied to Diprivan/Vented's topic in Certified Registered Nurse Anesthetist, CRNA

    jwk.... show me the literature that shows that there is an increased incidence of documented aspiration in mechanically ventilated patients by LMA vs ETT.... in fact, if you look at the literature (if...

  17. Is it possible to titrate paralytics?

    Gotosleepy replied to Diprivan/Vented's topic in Certified Registered Nurse Anesthetist, CRNA

    actually the lethal part of the injection is a bolus of Potassium Chloride - the paralytic is just to make the patient look at peace for the

  18. Post graduate anesthesia education

    Gotosleepy replied to sonessrna's topic in Certified Registered Nurse Anesthetist, CRNA

    some places offer extra months of focused clinical exposure - i know of 2 centers that provide 6 months of peds exposure.... if you want to be at the level of a fellowship trained MDA i can only...

  19. Post graduate anesthesia education

    Gotosleepy replied to sonessrna's topic in Certified Registered Nurse Anesthetist, CRNA

    there are no pain fellowships for CRNAs.... the aana is still trying to get that whole mess

  20. Washington, D.C. CRNAS

    Gotosleepy replied to pnurseuwm's topic in Certified Registered Nurse Anesthetist, CRNA

    deepzzzzz.... what a pompously annoying post... but since this is a CRNA board, i guess posts like these are allowed.... if i can presume to paraphrase your long tedious post: MDAs are balding,...

  21. Is it possible to titrate paralytics?

    Gotosleepy replied to Diprivan/Vented's topic in Certified Registered Nurse Anesthetist, CRNA

    like i said earlier paralytics in an unintubated patient should only be provided by an anesthesiologist/CRNA.... and definitely should not be used as a means to manage confusion/restlessness in the...

  22. Is it possible to titrate paralytics?

    Gotosleepy replied to Diprivan/Vented's topic in Certified Registered Nurse Anesthetist, CRNA

    oh the list goes on and on... recent tracheal resection and reconstruction for dilation... suspension microlaryngoscopy... TURP w/ obturator nerve stimulation (and you don't want the patient to kick...

  23. Is it possible to titrate paralytics?

    Gotosleepy replied to Diprivan/Vented's topic in Certified Registered Nurse Anesthetist, CRNA

    i said that you can paralyze a patient just as long pt is sedated (and won't be aware of paralysis) and just as long as there is an anesthesia provider at the bedside to maintain/secure the airway.......

  24. Is it possible to titrate paralytics?

    Gotosleepy replied to Diprivan/Vented's topic in Certified Registered Nurse Anesthetist, CRNA

    actually you can use paralytics in somebody who isn't intubated... but they need to be sedated as well, and you need an anesthesia provider

  25. Type of anesthesia used during tubal ligation?

    Gotosleepy replied to NewEnglandRN's topic in Certified Registered Nurse Anesthetist, CRNA

    Tubal ligations can absolutely be done under spinal.... the gynecologist just has to insufflate less CO2 and have good fiberoptics to provide good lighting, and then aspirate all the CO2 out of the...