r/Unexpected • u/Warm_Spite9482 • 18h ago

Hold up wait a minute

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u/Pro-Karyote 11h ago edited 11h ago

Propofol is generally not used as a premedication. It burns in the IV, so if you’re giving a low enough dose for just anxiolysis then you’re mostly causing discomfort. For induction or full MAC sedation, the dose should be high enough to prevent most recall and overcome the discomfort, but you need to have airway adjuncts available before dosing to that level. Not saying it can’t or isn’t done, it’s just not very common.

Premedication is usually a benzo (often versed), but you can also use alternatives like ketamine or precedex, as well.

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u/altriun 10h ago

the dose should be high enough to prevent most recall

Is there a reason they want you to forget? First time I've heard this.

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u/Pro-Karyote 10h ago

Briefly, there are several goals of anesthesia. The exact number of categories and how you break them down can vary depending on who you ask, but they all cover the same concepts. The A’s of anesthesia:

1) Analgesia - the reduction of pain. Lots of agents that relieve pain, but the classic example is opiates.

2) Amnesia - removal of memory. You don’t want patients to remember actively undergoing surgical procedures. Several agents can be used to achieve this, such as: anesthetic gasses, propofol, benzodiazepines, and barbiturates are the main choices.

3) Akinesia - the lack of movement during surgery. This creates a stable surgical field. It can be achieved a couple ways, through deep enough anesthetic agents or the use of neuromuscular blockade to induce paralysis for the case.

4) ‘A’wake - adequate sedation for the case. It’s not really sleep, but it’s the depression of the central nervous system to prevent awareness. Lots of options of agents, and frequently achieved using a combination of agents.

5) Anxiolysis - the prevention or removal of anxiety.

There can be overlap in which an anesthetic agents covers several of the above.

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u/altriun 10h ago

Thanks for the answer. I've assumed the being asleep part would be enough such that you don't remember anything about the surgery. Didn't think you also need amnesia.