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Post by A Schutter on Mar 27, 2020 10:41:02 GMT -5
1. I have used the circuit under the drape with 10L FGF and/or have also used the suction catheter under the drape when not being used by the surg. tech. I have not had any problems with hypercapnia in the past that I am aware of. 2. As an anesthesia provider vigilance is always crucial regardless of the type of anesthesia we are providing.
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nanci
Junior Member
Posts: 57
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Post by nanci on Mar 31, 2020 15:57:23 GMT -5
1. Given the current resources in Wilmer, are we able to decrease FiCO2 to an acceptable level under MAC. Why or why not? I believe currently we use supplemental oxygen given via Nasal Cannula with the ETCO2 monitoring. I also use the high flow insufflation of oxygen/air under the drapes and the use of the face drape (if surgeon allows and/or requests). We do not have a ambient CO2 monitor that can also be placed under the drapes (maybe we can get someone to make such a monitor that would alarm if the CO2 gets too high of a level) specific for these procedures. Hopefully these measures help to decrease what is being accumulated underneath the drapes.
2. After reading about the issues mentioned in this article, can we continue to think of MAC as "just sedation". Will this article make you more vigilant during these types of procedures? I think that after we read anything about anesthesia we are more vigilant concerning that topic for awhile and/or even change our practice to accommodate new information/evidence. I am not sure that I think of any case as "just sedation" but as the best anesthetic choice for that particular set of circumstances and attention given to each anesthetic. We all know that circumstances can change in mere moments and that vigilance is needed for every anesthetic.
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Post by emedina1 on Mar 31, 2020 16:01:44 GMT -5
My practice is 100% in an out patient surgery, mostly sedation. After reading this article I had been more vigilant of the the co2. in this setting ,we have what we call nyvias drape. This enable the drape to be away from the patient's nose thus affording a free flow of o2. Also we can dial in 10 liters of air to lower the accumulation of co2 around the patient's airway and face.In this setting most of the patients are ASA 2 or more. I don't really think that we can be less careful with them.
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Post by emedina1 on Mar 31, 2020 16:06:08 GMT -5
Hi Nanci, have you used the Nevia's drape? after reading this article, I always use it specially in long posterior cases and had a very reasonable co2 accumulation aroundd the patient under the drape.
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March FY20
Mar 31, 2020 19:41:15 GMT -5
via mobile
Post by Lu Lin on Mar 31, 2020 19:41:15 GMT -5
1.Yes, we normally decrease FiCO2 to acceptable levels using the drape holder and air insuflation under the drapes.
2. I believe Vigilance is necessary whether MAC or GA.
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Post by angie brooks on Mar 31, 2020 19:53:11 GMT -5
1. Given the current resources in Wilmer, are we able to decrease FiCO2 to an acceptable level under MAC. Why or why not? We are not currently doing very many eye cases at Bayview however when we did have them most were done with a block. In that case, it is not necessary to highly sedate the patient. I always made sure that the drape was tented well and the patient had an ETCO2 monitor in place.
2. After reading about the issues mentioned in this article, can we continue to think of MAC as "just sedation". Will this article make you more vigilant during these types of procedures? There is no anesthetic that is "just" anything. Our job is to remain vigilant at all times when the patient is under our care regardless of how much or how little anesthetic they are receiving.
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Post by C. Velarde on Mar 31, 2020 22:01:40 GMT -5
1. I think that the drapes propose a problem for the accumulation of ETCO2 . Many doctors just want a quick sedation for the block and have them stay awake for the procedure to prevent the sudden wake up and startle movement under the drapes. I think this is the best approach to avoid confusion and sudden movement. ETCO2 is monitored during the procedure with a nasal cannula. 2. Mac is not just MAC especially with an older, vulnerable population . Vigilance is always necessary especially when the patient is usually 90-180 degrees away and fully covered during the procedure.
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