ANESTHESIA ALERT
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O U T P AT I E N T S U R G E R Y M A G A Z I N E O N L I N E | N O V E M B E R 2 0 1 4
mon sufentanil infusion. I may have to use 2 vials of remifentanil,
versus 1 vial of sufentanil, which initially doubles the cost, but the
technique I use more than offsets the additional cost by dramatically
shortening recovery times. I do it by carefully working in fentanyl,
Dilaudid/morphine and IV acetaminophen toward the end of the
case. That lets most patients wake up within 30 seconds to 2 or 3
minutes of the time they're flipped over. They can respond to com-
mands and move all extremities, with little to no pain. The bottom
line is less OR time, less recovery time, fewer anesthesia-related
post-op complications and reduced manpower requirements. With
sufentanil drips, I've seen cases in which the infusion wasn't cut off
in time and the patient had to be taken to PACU while still intubat-
ed. Even when patients are cut off at the appropriate time, sufen-
tanil drips usually force them to stay in recovery a lot longer.
The ending.
For the last 10 or 15 minutes of a case, I cut the gas
off completely and cut flows down to 0.5 L/min, the idea being to
approximate a closed system as much as possible. I try to use about
150 mg of propofol on induction, so I'll have enough at the end of the
case if the patient gets a little light while closing. I let the patient wake
up slowly during closure, and flush out the system at the end for a fast
wakeup. The patient stays asleep and doesn't require any new inhaled
agent while closure, which is less stimulating, is occurring.
The bottom line: Patients wake up faster with less pain and fewer
complications, and as a result, many bypass recovery and go straight
to an area where they're able to eat and talk to their families. Now
they're getting sugar in their blood and their brains are more alert,
because they're talking and not just lying there. And the more they
talk, the faster they're getting the anesthesia out of their bodies.
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