Tiva

I absolutely love TIVA - I have used it a few times during outpatient surgery....mainly plastics. I usually use a propofol/alfenta drip or propofol/remi drip - the patients wake up really smoothly, no coughing, and no nausea. They are also usually euphoric....I get lots of "oh thank you so much, you are wonderful!" when I use TIVA.

The propofol/alfenta mix is a 50cc bottle of propofol (10mg/cc) and a 5cc amp of alfenta (500mcg/cc), and you run it 0.5-3mcg/kg/min. The prop/remi gtt is 0.05-2mcg/kg/min, (using a 50cc bottle of propofol and 1mg of remi). You can also use straight propofol 100-300 mcg/kg/min. Remember to give some narcotic for pain control if you use straight propofol, and also give something a little longer-lasting if you use remi or alfenta...they will wear off quickly.

vinny

- we use propofol and remi gtt - propofol usually 120-180 mcg/kg/min and remi we mix 2mg/40cc and titrate to pt need...

1. we use 2 IV's - one for your IVF and IV meds the other for your infusion

2. about 40 min prior to end turn off your remi and start titrating in fentanyl for longer lasting pain relief (could use morphine or dilaudid for even longer action) and start titrating your propofol down

3. usually for the last 20 min or so i run the propofol at 75 mcg/kg/min and 10 min prior to end shut it off - in my limited experience - obese individuals hold on to it forever and it takes a llloooonnngg time for them to come up...

good luck - you will do great...

on another not - collegues use a little ketamine in the propofol to counteract the decreased BP ect by increasing the HR - it of course is a wonderful analgesic...