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N&PD Moderators: Skorpio
What drugs are used in surgery for anaesthesia ?
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amapola
Bluelight Crew
Anesthetics cause you to lose sensation.
Analgesics cause you to not feel pain while keeping sensation.
I bet wikipedia has a whole list of them for you with all the bajillion contraindications and dosing which takes years to learn. I'll even go so far as to guess what the link is...wikipedia.org/wiki/Anesthetic let me know if I guessed right
Hyperthesis
Bluelighter
indelibleface
Bluelight Crew
It really depends on the doctor and what procedure. There are many different chemicals used, some simply for knocking you out, and others to prolong unconsiousness. It's a multifaceted question.
When I got all four of my wisdom teeth out at once, they only used sodium methohexital IV, a barbiturate. It was a 45 minute procedure. They also used a local anaesthetic, probably Xylocaine, to numb me post-procedure. The type of substance(s) used is, again, fine-tuned to the procedure performed.
negrogesic
Bluelight Crew
My specialty.......
Anesthetic agents varying immensely; the agents used (or not used) are a function of many variables. The number of variables are far greater than most people think, even greater than I had imagined(I was very much accustomed to veterinary anesthesiology; humans are trickier beasts, and they complain). In lengthy invasive surgeries anesthesiology can become even trickier (cardiothoracic anesthesiology for instance). You'd be surprised how many deaths via "complications from surgery" are the result of anesthesia.
On the most basic level, what is the surgery for (what is the procedure called); what is the weight, age, sex and "health" of the patient (any relevant disorders, obesity, current medications)? Tell me this and I can tell you what agents will likely be used, or at the very least, what agents I would personally use on said patient for said procedure.
On a side-note: In terms of insurance/law-suits, it is technically "cheaper" for someone to die during surgery then "live to tell the tale". For instance, if the patient dies, the surviving family may, in some cases of "negligence" or "malpractice", be compensated up to roughly $2 million. However if a patient "wakes up" during an invasive procedure and survives with vivid and accurate memory of the procedure, they can sometimes be compensated in the many millions. And no, as far as I know, anesthesiologists do not intentionally kill patients who obviously regain consciousness during a procedure; the expensive insurance will generally cover such incidents.
amapola
Bluelight Crew
^Are there drugs you can give a patient after they have woken up during surgery to interfere with their memory such that they don't remember that they did wake up, or do they have to be given preemptively to achieve amnesia?-DMO-
Greenlighter
Hello BL, longtime reader, first time poster. To answer the OP question i have to agree with the others. It will depend a great deal on the doctor, the type of surgery, patient history etc. etc
Some of the common ones are; fentanyl, propofol, and ketamine. To answer amapolas question, versed is a forget all drug and is usually given pre-op with fent to ease the paitents worries.
Hope this helps
vortex30
Bluelighter
I'm just interested to see what you would use on me, since no one else answered this!
Let's say the surgery is for a severely broken ankle/foot (shattered type dealio, so I'm thinking a moderate length of surgery, maybe 3-4 hours? you would be more qualified than I to say how long this surgery may last though, so if it is shorter/longer then adjust accordingly).
Age = 20 (almost 21, though I doubt that specific is needed)
Weight = 145 pounds
Sex = Male
Health = Pretty good but not perfect. I have slightly high-blood pressure (135/90 or there abouts I believe, this was in August), I'm a smoker, drug-user (previously abuser, for past year or so I've been 'moderate'), but I'm also athletic, eat very well, tend to heal quickly and not get sick often, basically I've got a perfect body/good genes, but I've messed around with substances enough that I do have some worries about health, etc.
No current medications.
No allergies.
Thanks, this will be kind of interesting!
Oh and what sorta pain meds am I looking at after surgery and for how long? Hehehe! Will they adjust for my opiate tolerance? (probably not I suspect, lol, oh dear...)
Hyperthesis
Bluelighter
IIRC they (=usually benzodiazepines) have to be administered preemptively, ie. before the surgery.
indelibleface
Bluelight Crew
Midazolam is most commonly used to induce amnesia.
negrogesic
Bluelight Crew
Age = 20 (almost 21, though I doubt that specific is needed)
Weight = 145 pounds
Sex = Male
Health = Pretty good but not perfect.
high-blood pressure 135/90 or there abouts I believe
Smoker, drug-user (previously abuser, for past year or so I've been 'moderate')
Athletic, eat very well, tend to heal
No current medications.
No allergies.
Thanks, this will be kind of interesting! Oh and what sorta pain meds am I looking at after surgery and for how long? Hehehe! Will they adjust for my opiate tolerance? (probably not I suspect, lol, oh dear...)
I am guessing you have a bimalleolar fracture of the ankle; I have experienced one myself and it was extremely painful. The recovery was long; I was wheelchair bound, then crutches, then a brace, and didn't "walk" along until month 6 post-op. Below is what the fracture looks like, and the post-op x-ray (looks very similar to mine).
This is typically a 2-4 hour surgery, depending on the skill of the orthopedic surgeon(s), severity of the injury, condition of the bone to which the bracket and screws are affixed, complications etc.
For the general, you are looking at a pretty typical endotracheal anesthesia. Endotracheal intubation is used for procedures (such as the one you will undergo) that are rather invasive and of moderate to unknown duration (given complications). In some cases, I request for blood and urine toxicology if the situation is tricker or the patient is a "known" drug-abuser.
In your case, as I do with most adults under similar circumstances, I use midazolam or in some cases other benzodiazepines for preoperative sedation and facilitation of intubation (has some muscle-relaxant properties). I would induce with propofol, do a "DAMMIS" check (drug-airway-mach.-mon.-IV-suction), and in your case, introduce sublimaze (fentanyl) into your line, which is a rather safe drug when used correctly. Plus, given your high blood pressure, the hypotensive properties are in this case desirable if properly controlled (the initial incisions often elicit some hypertension).
After successful intubation, I would in your case likely maintain post-induction anesthesia with a slow infusion of propofol. In very lengthy procedures sevoflurane is often used, but again, in your case I would go with a propofol infusion.
An older anesthesiologist may prefer sevoflurane due to their familiarity with the "vapors", but I see no need for it for your procedure. I find propofol to be much "cleaner" and more predictable, however, in veterinary medicine we almost exclusively used halothane for maintenance (far less expensive than a propofol infusion).
Unfortunately, the anesthesiologists role is generally limited to the time in which you are intubated, meaning that it will be up to the discretion of your orthopedic surgeon what script you will go home with. If you are undergoing the procedure illustrated above, you are NOT going home the same or likely the next or two at least. Or, optimally you shouldn't, but depending on your insurance etc, some hospitals tend to kick people out prematurely. Post-op, you will have a morphine drip, 10mg button etc (don't keep on pressing it, it doesn't work like that). There is a way to fool with the machine but I cannot disclose that for safety's sake.
You should go home with at the very least hydrocodone 7.5mg or 10mg, as this is a very painful recovery. Honestly, from personal experience, this procedure fucking hurts. Hopefully you can get some oxycodone, hydromorphone (works for some) or other opioid. I generally recommend duragesics for non-opioid dependent/abusers, and when dealing with opioid addicts, I will highly recommend or even impose myself that the patient be given methadone (for pain, not addiction). Obviously, this is not a popular request, "methadone" is a "bad-word", but honestly, it is a great, long-lasting and powerful analgesic. But physicians hate writing it for pain, largely in fear of raising the eyebrows of their superiors or the DEA.SugarTorch
Greenlighter
quote,
"This is typically a 2-4 hour surgery, depending on the skill of the orthopedic surgeon(s), severity of the injury, condition of the bone to which the bracket and screws are affixed, complications etc.
For the general, you are looking at a pretty typical endotracheal anesthesia. Endotracheal intubation is used for procedures (such as the one you will undergo) that are rather invasive and of moderate to unknown duration (given complications). In some cases, I request for blood and urine toxicology if the situation is tricker or the patient is a 'known' drug-abuser."
Mr. Negrogesic,
Why general anesthesia for the isolated ankle fx? If he is a young, healthy guy, wouldn't a spinal do the trick?Deleted member 137730
Greenlighter
- Joined
- Sep 21, 2009
- Messages
- 583
The most commonly used combo for light procedures such as wisdom teeth and colonoscopies is IV fentanyl starting at 100 mcg and pushing as needed along with 2mg versed pushed as needed. They generally have demerol on hand if you react strangely to fentanyl and they will push versed until your out.
For heavy, real surgeries things like propofol are used along with others like it. They rarely use shit like ketamine and barbituates anymore.
I didn't tell my doctors i was an opiate addict until i was on the operating table about to have my chest cut open, they had to push ten full syringes of normal fentanyl doses along with like five full syringes of demerol mixed in and like 12 mg versed and i was still awake and chillin enjoyin ma high.
KeepingThingsReal
Bluelighter
- Joined
- Dec 25, 2010
- Messages
- 137
Ketamine, Versed (midazolam), propofol, etc.
KeepingThingsReal
Bluelighter
- Joined
- Dec 25, 2010
- Messages
- 137
I am guessing you have a bimalleolar fracture of the ankle; I have experienced one myself and it was extremely painful. The recovery was long; I was wheelchair bound, then crutches, then a brace, and didn't "walk" along until month 6 post-op. Below is what the fracture looks like, and the post-op x-ray (looks very similar to mine).
This is typically a 2-4 hour surgery, depending on the skill of the orthopedic surgeon(s), severity of the injury, condition of the bone to which the bracket and screws are affixed, complications etc.
For the general, you are looking at a pretty typical endotracheal anesthesia. Endotracheal intubation is used for procedures (such as the one you will undergo) that are rather invasive and of moderate to unknown duration (given complications). In some cases, I request for blood and urine toxicology if the situation is tricker or the patient is a "known" drug-abuser.
In your case, as I do with most adults under similar circumstances, I use midazolam or in some cases other benzodiazepines for preoperative sedation and facilitation of intubation (has some muscle-relaxant properties). I would induce with propofol, do a "DAMMIS" check (drug-airway-mach.-mon.-IV-suction), and in your case, introduce sublimaze (fentanyl) into your line, which is a rather safe drug when used correctly. Plus, given your high blood pressure, the hypotensive properties are in this case desirable if properly controlled (the initial incisions often elicit some hypertension).
After successful intubation, I would in your case likely maintain post-induction anesthesia with a slow infusion of propofol. In very lengthy procedures sevoflurane is often used, but again, in your case I would go with a propofol infusion.
An older anesthesiologist may prefer sevoflurane due to their familiarity with the "vapors", but I see no need for it for your procedure. I find propofol to be much "cleaner" and more predictable, however, in veterinary medicine we almost exclusively used halothane for maintenance (far less expensive than a propofol infusion).
Unfortunately, the anesthesiologists role is generally limited to the time in which you are intubated, meaning that it will be up to the discretion of your orthopedic surgeon what script you will go home with. If you are undergoing the procedure illustrated above, you are NOT going home the same or likely the next or two at least. Or, optimally you shouldn't, but depending on your insurance etc, some hospitals tend to kick people out prematurely. Post-op, you will have a morphine drip, 10mg button etc (don't keep on pressing it, it doesn't work like that). There is a way to fool with the machine but I cannot disclose that for safety's sake.
You should go home with at the very least hydrocodone 7.5mg or 10mg, as this is a very painful recovery. Honestly, from personal experience, this procedure fucking hurts. Hopefully you can get some oxycodone, hydromorphone (works for some) or other opioid. I generally recommend duragesics for non-opioid dependent/abusers, and when dealing with opioid addicts, I will highly recommend or even impose myself that the patient be given methadone (for pain, not addiction). Obviously, this is not a popular request, "methadone" is a "bad-word", but honestly, it is a great, long-lasting and powerful analgesic. But physicians hate writing it for pain, largely in fear of raising the eyebrows of their superiors or the DEA.
When I went through surgery for shattering my elbow back in October (still can't extend my arm past 135%,[worst pain I've EVER fucking felt]), I was clouded the fuck up with morphine, fentanyl, oxymorphone, and other shit. But that just made me really foggy headed and nauseous. I literally didn't feel anything. (No I do not abuse opiates so it's impossible to have a tolerance).
During the ready-up for surgery, I think they used some more fentanyl. But then they broke out the midazolam, awwwww shit :D. Damn it was so fucking euphoric. I kept asking for more of it because I was fiening so hard every few minutes from a slight come-down. They dosed me up 4 more times, but then they told me no more because I would be puking my guts out. Woke up hours later. Some lady asked me something. Fell right back asleep for an hour to her face LOL. I kept trying to fall asleep because I didn't give a shit what she was saying. They were so annoyed.
They only sent me home with 5/500s sadly.
I'm currently going through more pain in physical therapy.
negrogesic
Bluelight Crew
Do the physical therapy; i did not, and it hurts to this day. Did you have a similar procedure to the one i described? What type of fracture specifically? Mine was a bimalleolar fracture.....
As to why this requires general- the surgery is rather invasive, involves removing the damaged bone, and requires quite a bit of drilling to mount the bracket (at least 6 screws total, my bimalleolar fracture required 8). The incision is deep and long (both sides for a bimalleolar, and is generally stapled shut, mine had 16 staples total, with some rather fancy stitching. A nerve block would not be a wise option, and considering all the drilling and smell of burning bone, no patient would want to remain conscious for this, that smell really sticks with you, even with a mask, it stinks. If someone were to wake up during this, i would be looking at a law-suit (this is why insurance is so expensive).............litigious americans...............