[kilimounjaro]

Paediatric anaesthesiologist here.

We mostly use propofol/remifent for maintenance of anaesthesia, and there is (some) reasonable evidence that this leads to less emergence delirium than sevoflurane. We use EEG-like monitors in all paralysed patients over a few months old.

Annoyingly I can’t access the full study, but would be interested to know why the kids in the low sevoflurane use group weren’t moving or coughing with surgical stimulation. The commonly used doses of sevoflurane are used because they are supposed to inhibit movement in response to noxious stimulus. So presumably these patients are all being paralysed or given a lot of opioid to stop them moving?

Using sevoflurane instead of propofol for maintenance if you are trying to reduce PAED is not really standard of care and makes me suspicious they are trying to overstate the effectiveness of their device.

[robbiep]

Here you go: https://drive.google.com/file/d/1y3_fgi0prAUjLugQWUDylZL_TN8...

[kilimounjaro]

Many thanks!!

[dr_dshiv]

I was surprised when my 7 year old son received a minor eye surgery (he had a random fleck of metal on the sclera) and they gave him a large dose of ketamine.

He remained conscious but was immobilized. I asked him what it was like afterwards and he said “dad, everything turned into legos!!”

[sawjet]

I was given ketamine as a 15 year old for a broken ankle that needed to be re-set. The nurse didn't tell what it was but I could read the label when she was filling up the syringe. It definitely didn't put me to sleep.

[tapoxi]

My family has a history of malignant hyperthermia, so I was recently put under without inhaled anesthetics and they put an EEG on me. It was wild, zero delerium, nausea, or grogginess. I just snapped back into full consciousness.

[kilimounjaro]

Propofol is great isn’t it! I worked with some old guys who did some of the original studies demonstrating safety of propofol anaesthesia in MH. The world is much better for people with MH than it was 30 years ago, as long as they have a way to inform their doctors of the condition.

[elric]

Was put under for minor surgery using propofol some 20 years ago. Doc started injecting the milky white goo into my IV, without so mucy as a hello, there was a clock in the room which seemed to slow down, I couldn't breathe or move or cry out and was sure I was dying.

Then I woke up in a recovery room, with zero awareness of anything that happened in between.

0/10, not an experience I'd recommend.

[bobowzki]

Always nice to see another anesthesiologist on hackernews, we're quite a few it seems. I have done research in this area and also worked a bit with Emery. Which/what brand EEG monitor do you use?

[slicerdicer2]

Hi :) Yes I think the combination of quite a bit of phone time during the work day and also being frustrated tech people makes HN good for us.

I use SedLine but have used entropy and BIS in the past.

Interestingly the study uses 1mg/kg roc in 40% of the patients and a lot of sugammadex, as well as a pretty decent dose 0.5mcg/kg/min remifent infusion.

[sillysaurusx]

> Annoyingly I can’t access the full study

If you post on https://www.reddit.com/r/scholar you’ll get access within 15 minutes or so. This is true of basically any paywalled academic article.

Just make sure you include a link to the actual paywall rather than just the doi.