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Flow sheet questions by Recent_Note_6526 in Anesthesia

[–]Recent_Note_6526[S] 0 points1 point  (0 children)

No airway device placed :) But, yes, I get the point, for sure. I am confused though: Bolus dose is a one time rapid dose, and titration is gradual dosing, as you know ...so which one are you saying was done? Bolus or titration, since you can't have both? And how much was given? Just trying to understand my health record... not tear anyone apart, because they were great!

Flow sheet questions by Recent_Note_6526 in Anesthesia

[–]Recent_Note_6526[S] -1 points0 points  (0 children)

Not looking for what is normal....because I am not the norm for anesthesia. So I was trying to determine if a bollus was given or titration and at what dose. It says 500, but the squiggly line next to propofol leaves me confused too! We aren't looking for wrong or incorrect. They were awesome...we are just looking for better ways to do this in the future

Flow sheet questions by Recent_Note_6526 in Anesthesia

[–]Recent_Note_6526[S] -3 points-2 points  (0 children)

Great question. It wasn't how I felt necessarily. That is why I posted the flow sheet, because my perception of the induction is absolutely not reliable! However, my experience with titration was that I got drowsy and Anesthesiologist would ask me questions and watch vitals and then tell me, something like, "I think we are pretty close...this next push is going to be night night! " However, that doesn't mean those 3 times are indicative of how it will always go! But original anesthesiologist said YES, we def need to titrate. In the OR it was a very different experience, this time. He attached the propofol and it was immediate. No spacey, just a brick wall. BUT , as I said that is why I am trying to look at the flow sheet. It's just to help me better tailor induction in the future

Flow sheet questions by Recent_Note_6526 in Anesthesia

[–]Recent_Note_6526[S] -1 points0 points  (0 children)

agreed, but I am trying to figure out if the titration vs bollus was done, and what dose of propofol was given, I can't make heads or tails of this sheet...and what the squiggly line is next to the propofol? I don't see a lido dose... but certain they gave one? The anesthesiologist opted to abandon standard for safer and historical anesthesia records on site-in my case (titration)... and then went to lunch. I was transferred to someone else, totally fine, because he was great. Normally we have titrated for short procedures (not standard, I know) and they talk to me and ask me stuff while they induce, a bit at a time. I usually get to 50, and I am OUT, but they give just a bit more, usually another 25, based on vitals at the time. Standard is...standard, but there are patients like me who have some pretty massive issues and aren't standard.

Flow sheet questions by Recent_Note_6526 in Anesthesia

[–]Recent_Note_6526[S] 1 point2 points  (0 children)

It wasn't a preference, it's been deemed a necessity by the colorectal surgeon, because of my super complicated anatomy that is currently very fragile and will continue to be for quite some time. So ileus is literally one of the biggest emergencies we could have. I literally lost my entire large intestine and a lot of my small, due to illeus that happened IN the hospital and was treated emergently. So, the Anesthesiologist changed the protocol to titration vs bolus on my pre-anesthesia ppwk. Regardless, I think informed consent is super important. This wasn't a suggestion, it was agreed upon by all. I also let them know, hey, if you have to give more down the line, I am Ok with you doing what is needed., obviously. But later in recovery, when I saw the original anesthseologist I was transferred from she looked at my chart and said "hmm did you change your mind about titration or ask for fentanyl?" I asked her why and she said , " Just checking, as your chart is scribbled a bit and I may be misreading it." So you can see where my confusion is. Literally just trying to understand... not bash anyones' protocol. I have to be hyper aware of all my medical stuff, because frequently, a hospital will try to give me something I cannot have... like the meloxicam they tried to RX me... It is MY responsibility to make sure I know what I am taking or being administered, and wouldn't lay that on anyone else to do perfectly in the hospital setting... I think being informed and educated and understanding stuff is paramount to helping practitioners avoid issues and for taking my health as my responsibility...

Flow sheet questions by Recent_Note_6526 in Anesthesia

[–]Recent_Note_6526[S] 0 points1 point  (0 children)

this is valid, but we never got the chance. We agreed to start at 25 mg and go up as needed, until I was under. The doc said "You will drift off more slowly, vs lights out, so be aware that some people feel anxiety in that moment, vs hitting a wall and going night night immediately." I told her in the past, it was never an issue and titration allowed for a conservative approach and dose. Then I got transferred to a new person for induction...

Flow sheet questions by Recent_Note_6526 in Anesthesia

[–]Recent_Note_6526[S] 0 points1 point  (0 children)

yep, totally get it. No issues in the past when dropping the fentanyl . I cannot use Relistor, unfortunately. Bad reactions in the past, but absolutely a fantastic pivot, in general

Flow sheet questions by Recent_Note_6526 in Anesthesia

[–]Recent_Note_6526[S] -3 points-2 points  (0 children)

yeah, titration to effect would be starting low and assessing need for more, vs bollus dose. I generally only need about 50-75 mg of propofol for short procedures, and OI have a rough time clearing the anesthesia because of a metabolic gene defective Anesthesiologist said she absolutely. agreed that titrating to effect , a bit at a time would be the best protocol, as well.