ketamine

by cma (no login)

 

First of all, an FP "clearing" a patient for anesthesia is absurd. What we want is for the patient to be optimized. i.e. a patient with COPD should not present for a GA with an acute exacerbation, a hypertensive patient should not present with BP 205/110

Sometimes we are interested in a cardiac evaluation including any stress tests, echos, caths etc.

"clearance" by an FP or internist is really completely useless. Orthopods where I practice routinely send patients to their FPs for "clearance" and the FP writes on a scrip pad "cleared for anesthesia" or some similar worthless phrase. And what's beautiful is these patients occasionally show up coughing large amounts of green sputum etc

The FP or Internist knows next to nothing about Anesthesia and I don't know a single Anesthesiologist who puts any value in their opinion. The most beautiful example I've ever seen is a hospitalized patient qho was being seen by several internists( cardio, nephro, etc.) and they all had written a note saying that since the patient had Aortic Stenosis she should have a spinal anesthetic. I'm still chuckling.

One of the worse scenarios for a patient is to be operated on in the office of a limited license practitioner with a CRNA (oral surgeon and CRNA). Neither of these practitioners has the full medical and anesthesia training that anesthesiologists have.

to answer some of your questions ketamine is almost the perfect anesthetic, except that an induction dose may leave the patient in a state of dissociation making it difficult to discharge them. One patient I had said it was like being in the movie "Matrix"
I rarely use it

A typical GA for ambulatory srgery would be fentanyl,lidocaine,propofol, muscle relaxant, zofran, toradol.

Posted on Sep 23, 2002, 10:17 PM
from IP address 209.183.88.115

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Response TitleAuthor and Date
Re: ketamineAnonymous on Sep 24, 10:10 PM
 gacma on Sep 25, 5:24 PM
cma, thanks...Anonymous on Sep 25, 1:10 AM
 not one mindedcma on Sep 25, 5:45 PM

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