AnaConDa volatile agent delivery for unit patients

[VentdependenT]

http://www.sedanamedical.com/aboutanaconda_icu.php

I would friggen love to get my hands on this thing!

Crack some isoflurane and dump everything except some narcotics. awesome! You guys ever see one of these in use?

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[jdh71]

Cool.

They will need to prove better outcomes outside of the theoretical or it will never take off at all.

Be nice to try it for ZOMFGasthma cases.

 

[Hernandez]

Clearly this won't be marketed towards pulm-cc, I doubt any have had training using inhalational anasthestics.

 

[jdh71]

Clearly this won't be marketed towards pulm-cc, I doubt any have had training using inhalational anasthestics.

I was thinking the same thing, but if there really isn't much to know, then . . .

Take a weekend course . . .

 

[Hernandez]

I was thinking the same thing, but if there really isn't much to know, then . . .

Take a weekend course . . .

Where I trained, the gas peeps had a "only-ones" mentality about their specialty.......except when they were training the nurses to do it.....the long and short of it is, I could see a massive turf war over using something like that.

 

[jdh71]

Where I trained, the gas peeps had a "only-ones" mentality about their specialty.......except when they were training the nurses to do it.....the long and short of it is, I could see a massive turf war over using something like that.

You may be right, but that would be ruhtarded - running gas into a vent for sedation is hardly what anesthesia does in the OR, which is so much more. Whatevs. I wouldn't fight them too hard for it. Though it seems to me that it's not the kind of work that most of the OR guys would want to do and it also seems to me that if it truly is better, we'll just start using it anyway and they can go f*ck-all.

 

[VentdependenT]

Working with volatiles is not difficult. i could teach any interested cc doc about isoflurane in 30 min. Basically all we would need is isoflurane (not des or sevo). Its cheap, easily titrated, and safe.

 

[Stank811]

Working with volatiles is not difficult. i could teach any interested cc doc about isoflurane in 30 min. Basically all we would need is isoflurane (not des or sevo). Its cheap, easily titrated, and safe.

I see disaster written all over that device...the logistics and implications of using a volatile anesthetic that a nurse would have to adjust with boluses into an instrument that delivers it in variable concentrations depending on MV...I will be sticking to IV sedation...pts code enough the way it is on their own they do not need any additional help.

Not sure when the last time you looked over volatile anesthetics and their effects on physiology but I think it would take a little bit longer than 30min for a IM doc to grasp what they were getting themselves into with that device.

 

[psychbender]

The PICU at the nearby children's hospital has used iso a few times for sedation in kids with status. From what they told me last year, it worked quite well, but just required close coordination with the anesthesiologists, as the intensivists were unfamiliar with volatiles.

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[Stitch]

Cool.

They will need to prove better outcomes outside of the theoretical or it will never take off at all.

Be nice to try it for ZOMFGasthma cases.

The PICU at the nearby children's hospital has used iso a few times for sedation in kids with status. From what they told me last year, it worked quite well, but just required close coordination with the anesthesiologists, as the intensivists were unfamiliar with volatiles.

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One of our EM docs downstairs believes in aggressive intubation of asthmatics if their CO2 hits 50 (not kidding). So I unfortunately get decent training in these kids a few times a year. We have an anesthesia vent set up with iso ready to go, and I think it works well, but as mentioned, we collaborate with our anesthesia colleagues frequently. We've definitely prevented an ECMO run or two by using iso. Something like the AnaConDa would be nice because the anesthesia OR vents kind of suck and aren't as versatile as our servo vents.

 

[VentdependenT]

I see disaster written all over that device...the logistics and implications of using a volatile anesthetic that a nurse would have to adjust with boluses into an instrument that delivers it in variable concentrations depending on MV...I will be sticking to IV sedation...pts code enough the way it is on their own they do not need any additional help.

Not sure when the last time you looked over volatile anesthetics and their effects on physiology but I think it would take a little bit longer than 30min for a IM doc to grasp what they were getting themselves into with that device.

I disagree with most of what you say. We use ISO on super sick pts in the OR at higher doses than we would ever need in ICU. Throw in fentanyl and your talking MAC of .25. Cmon man

 

[Stank811]

I disagree with most of what you say. We use ISO on super sick pts in the OR at higher doses than we would ever need in ICU. Throw in fentanyl and your talking MAC of .25. Cmon man

I am not arguing against the use of volatile anesthetics for sedation I am arguing about the logistics of using the device you posted about. You will have nursing staff blousing ISO based of a nomogram that is dependent on the MV of the patient. I quickly browsed the website several days ago and the nomogram they provide is to deliver .5% Vol. Is it even sensitive enough to deliver .25% at a constant level and then it states that with a bolus it will increase the dose of ISO from .2-.6% vol...I am just a little doubtful this device will work as smooth as you think.

And I still disagree with your statement that an IM trained internist only needs 30min of training to safely use ISO in the ICU when they likely have read zero about ISO.

If you want ISO in the ICU just get a vaporizer...just seems like the AnaConDa is taking a step backwards from what already has been used for decades in the OR.

 

[VentdependenT]

Ok. How long do you think it would take to teach and educated intensivist about practical application of ISO as an agent for MAC amnesia? How long did it take you to understand the fundamentals of this agent? How much of the details did you retain? How applicable are the details to clinical practice of sedation on intubated patients in closely monitored settings?

We dont even understand how volatile agents produce their clinically useful effects for the application of general anesthesia.

 

[logos]

I did a pediatric anesthesia rotation. They tell you the number they set each agent on typically. Then during your cases you adjust the little dial thing on the machine. HR goes up or patient moves go up, blood pressure goes down then dial down. No prob.

 

[proman]

Ok. How long do you think it would take to teach and educated intensivist about practical application of ISO as an agent for MAC amnesia? How long did it take you to understand the fundamentals of this agent? How much of the details did you retain? How applicable are the details to clinical practice of sedation on intubated patients in closely monitored settings?

We dont even understand how volatile agents produce their clinically useful effects for the application of general anesthesia.

We had the inventor give grand rounds. The device runs off sevo. I didn't see anything about it that made me think it was a good idea.