Page 20 - CASA Bulletin 2019 Vol 6 No 4

CASA Bulletin of Anesthesiology

methadone 15-20 mg with small dose of fentanyl on sternotomy. We can extubate 50% of the
patients in the OR. Most of my patients with the first example requires minimal (sometimes 0)

opioids until next morning even for open abdominal surgery like Whipple. We start po opioids

afterwards. ( 汪红 西弗吉尼亚大学 )

Discussion 4.4: Agree with Duramorph, excellent analgesia, our hospital policy requires postop
pulse ox monitor for pt receiving intrathecal duramorph except for OB pt though, which means

ICR level care and it limits our pt flow from PACU. Methadone is also great if used properly.

We don’t use it frequently enough. ( 王萌）

Discussion 4.5: We do acb (adductor canal block) catheter pre op then spinal for tka( knee re-
placement). (Jack Zhang)

Question 5: 汪红 , ketamine drip? Or bolus? Dose? I used ketamine on three cardiac pts in the

past. 50mg IV during induction, another 50 mg at near the end of surgery. Fentanyl was 500-

1000 mcg in total. Two pts did well as usual in ICU. One pt developed agitation during weaning
off ventilator in ICU. I hold off ketamine for now. ( 唐越 )

Discussion 5.1: The following paper is what we have been doing in the last two years for cardi-

ac cases in which we implemented a cardiac ERAS protocol. In this protocol, we used only 100-

250ug of fentanyl because of ketamine drip. And near 30% pts are extubated in the OR and over
75% of total are extubated within 6 hours postop—all these are associated with better outcome.

(Weidong)

Discussion 5.2 高卫东 , I got your protocols on ERAS. So far, our cardiac surgeons support it.
We will explore it on August 1st . We are debating to use ketamine or precedex. (唐越)

Discussion 5.3: There is a small sample report that ketamine may increase postoperative delir-

ium in cardiac surgery patients. I used to use ketamine for all my cardiac surgery patients but

changed the practice recently. ( 汪红 西弗吉尼亚大学 )

Discussion 5.4: One of my colleagues tried precedex drip on cardiac case. Pt was struggling in
the ICU and brought back to OR due to bleeding. I am not sure how much fentanyl pt received

during the surgery. It seems we face the learning curve. ( 唐越 )

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