Random Thought of the Day

I used fentanyl 7 times today. For my patients, that is. An average adult I give 100 MICROGRAMS as a sedative/analgesic just before I put them to sleep, usually with propofol. Patients react quite differently to the drug. Some are almost put to sleep by that low dose, and others barely notice that I gave them anything. I'm guessing a milligram would be enough to kill most people via respiratory depression. I've seen patients stop breathing with a lot less. I'm talking IV, by the way.
I don't think carfentanil was ever approved for human use. I did use IV sufentanil, maybe 10 times as strong as regular fentanyl, for many years. It was no big deal. Instead of 100 mcg at a time, used 10mcg doses.

Quote: SOOPOO

I used fentanyl 7 times today. For my patients, that is. An average adult I give 100 MICROGRAMS as a sedative/analgesic just before I put them to sleep, usually with propofol. Patients react quite differently to the drug. Some are almost put to sleep by that low dose, and others barely notice that I gave them anything. I'm guessing a milligram would be enough to kill most people via respiratory depression. I've seen patients stop breathing with a lot less. I'm talking IV, by the way.
I don't think carfentanil was ever approved for human use. I did use IV sufentanil, maybe 10 times as strong as regular fentanyl, for many years. It was no big deal. Instead of 100 mcg at a time, used 10mcg doses.

I think I have a natural tolerance to opioids. I’ve never had major surgery, but when they put me to sleep for wisdom teeth removal I remember waking up several times during the procedure and they had to give me more of whatever drug they use.

The few times I’ve been prescribed opioid painkillers, I have not felt a thing despite taking a few extra.

Is that something I should tell the anesthesiologist if I ever have surgery? I am terrified about waking up mid procedure for something more invasive than oral surgery.

SOOPOO, before my surgery last week the Anesthesiologist came into the pre-op room and gave me a sedative that he said would just feel like I had a couple of beers. I remember absolutely nothing after that. Sadly, I wanted to really look around the operating room and look at the robot setup but instead I missed it all. My wife said I was still conscious and talking when they took me to the O/R, but I remember nothing.

What was likely the drug he would have given me at that point? I never did ask him but I was assuming it was probably Versed or something similar.

I woke up during a stent emplacement, I've had surgery wherein the surgeon forgot the anesthetic, is it any wonder I don't trust them at all.

Quote: SOOPOO

I used fentanyl 7 times today. For my patients, that is. An average adult I give 100 MICROGRAMS as a sedative/analgesic just before I put them to sleep, usually with propofol. Patients react quite differently to the drug. Some are almost put to sleep by that low dose, and others barely notice that I gave them anything. I'm guessing a milligram would be enough to kill most people via respiratory depression. I've seen patients stop breathing with a lot less. I'm talking IV, by the way.
I don't think carfentanil was ever approved for human use. I did use IV sufentanil, maybe 10 times as strong as regular fentanyl, for many years. It was no big deal. Instead of 100 mcg at a time, used 10mcg doses.

What do you do for patients already taking buprenorphine or suboxone? How are they medicated post surgery?

Quote: DRich

but I was assuming it was probably Versed or something similar.

Yes. Versed you saw and heard but you don't remember.

When you're under good general anesthesia, they can slice you up, drill through bones, etc., Makes me wonder how bad death really can be when sufficiently sedated.

Quote: petroglyph

suboxone?

" I might as well snort a Splenda" Elizabeth Clayton, addict in Bosch Season Five and his wife in Season Six.

Quote: DRich

What do you think the 60mg Hydrocodone go for?

It looks like Hydro is about the 1=1 morphine equivalent. Whereas Oxycodone is equal to 1.5 Hydro. https://clincalc.com/Opioids/ ymmv

A 60mg Hydro appears to be about 45mg morphine equivalent. Just a touch over the max allowed in Az. per day, per the Governors orders. Governor Ducey has ordered 40mg morphine equivalent to be the maximum dosage allowed for chronic pain sufferers in Az. I don't know it that's the same limit nationwide. But I believe something like that is the intent. Patients aren't even warned.

No one can match story's with an anesthesiologist for dosing but, I've met pain patients taking 500mg oxy per day.

I can't imagine the horror brought on them, now that the government is setting maximum dosages for chronic pain . They show up to fill their scripts and find out right there, they need to cut back instantly from a dose they've been accustomed to for years, now is reduced down 90%. Without even time to titrate. That is where a lot of the suicides are coming from. Those people that have never committed a crime, nor do they know how or where to locate sufficient street opiods, because every dose they have ever taken has been lawful , are sent into an unimaginable terror and pain. Unintended victims of the war on drugs, with no lobby. The very people the drugs were produced to help.

Meanwhile in New Mexico next door, their governor declared open borders and booted out the national guard, which left next to nobody watching the border. So the cartels figured out when they have a shipment ready, they have brigades of family's charge the border all at once and the the drugs come across at a different location. Every cop in the state has to rush toward the border to assist with the migrant charge. That leaves on 3 DEA agents to cover the middle of the states two north south highways. There's semi trucks full of narcotics rolling north next door, while patients can't get scripts in Az.

It would be quite the challenge to your moral code, to watch your loved one go through that pain, for the reasons and circumstances given. Meanwhile in Az. [yes thank you governor] you can go to jail for a year, for the first offense, if you get caught with one joint.

Quote: Fleastiff

" I might as well snort a Splenda" Elizabeth Clayton, addict in Bosch Season Five and his wife in Season Six.

lol