In those patients with highly reduced LVEF you might consider using low dose Epinephrine (e.g. 0.05µg/kg/min) or Dobutamine p.cont., possibly in parallel with Noradrenaline 0.05µg/kg/min (and then adapted to BP and HR) from the start of induction.
A lot of varying dose ranges, a bit confusing as textbooks mention different doses than the ones presented here ..so I’m guessing dosing comes with experience and getting a “ feel” for how patients react ??
Fascinating thanks. I'm here searching for how surgeon @ Royal Melbourne was able to waken me to communicate during surgery. I had 5 separate lines of anaesthetic of various names running into injuries. Simply telling me to relax again put me back to sleep. Awoke in I.C.U.
I dont actually… alcohol chronic use theoretically needs more hypnotic… But as far as ive seen… any tolerance is a drop in the ocean of the activity of propofol… The only factors that have contributed to needing higher dose clinically significantly have been age and size
I’ve used etomidate a good number of times with low EF patients. I usually go to .3 mg/kg for induction bc it seems to take a little more to be effective. Though it does maintain adequate BP compared to propofol. A lot of times though , I’ll just go slow and low dose on propofol with a preceding dose of neosynephrine. I guess you guys use metaramanol instead of neosynephrine?
Just started my residency this week and this kind of material is awesome! Thanks!
Great to hear!
Really helpful discussions and tips,soon to join the speciality
Good luck!
In those patients with highly reduced LVEF you might consider using low dose Epinephrine (e.g. 0.05µg/kg/min) or Dobutamine p.cont., possibly in parallel with Noradrenaline 0.05µg/kg/min (and then adapted to BP and HR) from the start of induction.
A lot of varying dose ranges, a bit confusing as textbooks mention different doses than the ones presented here ..so I’m guessing dosing comes with experience and getting a “ feel” for how patients react ??
hello from Morocco !
hello!
I believe etomidate is one metabolized by plasma esterases
Fascinating thanks. I'm here searching for how surgeon @ Royal Melbourne was able to waken me to communicate during surgery. I had 5 separate lines of anaesthetic of various names running into injuries. Simply telling me to relax again put me back to sleep. Awoke in I.C.U.
Thats a very interesting anaesthetic method for awake craniotomy….
Google asleep awake asleep method for awake craniotomy..
www.mayoclinic.org/tests-procedures/awake-brain-surgery/about/pac-20384913
Thanks for information. In my case I was awoken to insert lung drainage larding needle.
Do you adapt the dosage of Propofol if the patient is a smoker or regularly drinks alcohol?
I dont actually… alcohol chronic use theoretically needs more hypnotic…
But as far as ive seen… any tolerance is a drop in the ocean of the activity of propofol…
The only factors that have contributed to needing higher dose clinically significantly have been age and size
I’ve used etomidate a good number of times with low EF patients. I usually go to .3 mg/kg for induction bc it seems to take a little more to be effective. Though it does maintain adequate BP compared to propofol. A lot of times though , I’ll just go slow and low dose on propofol with a preceding dose of neosynephrine. I guess you guys use metaramanol instead of neosynephrine?
When’s this ep going up on Spotify boys? Keen for a listen on my commute
Hi Sean! It’s already on spotify…
open.spotify.com/show/1WSwYFcU95KBvAcozvWfWF?si=qEI4iJ6TSjanNBHwwnoOTQ&dl_branch=1
Hey Sean! so Sorry, I didn't realise I did publish yet on Spotify.. it'll be out tomorrow :)
Hy from Sokoto
vaw.fyi
good