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Vapor: If we can’t live with it, can we live without it?

Vapor: If we can’t live with it, can we live without it?. Reid Rubsamen, M.D. Staff Anesthesiologist OR Medical Director John Muir Medical Center Walnut Creek, California. Relevant Financial Relationships: None.

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Vapor: If we can’t live with it, can we live without it?

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  1. Vapor: If we can’t live with it, can we live without it? Reid Rubsamen, M.D. Staff Anesthesiologist OR Medical Director John Muir Medical Center Walnut Creek, California

  2. Relevant Financial Relationships: None • I will be speaking about drugs for the induction and maintenance of anesthesia and about intra-operative awareness monitoring. • I paid my own way to this meeting and I am not a paid consultant to any relevant companies.

  3. CF3 Cl F F F O O F CF3 F F F F O CF3 F F CF3 F O F CF3 Sevoflurane Isoflurane Desflurane 3M Dry Cleaning Fluid

  4. Motivation • Inhalational anesthetics are basically medical grade organic solvents. • New technology makes it possible to reduce or eliminate vapor from anesthetic practice. • I have conducted approximately 2000 anesthetics with total intravenous anesthesia (TIVA) without prophylactic use of anti-emetic drugs and without vapor or nitrous oxide. • Patients wake up more smoothly compared with my own experience using vapor.

  5. Dramatic Short Term Side Effect Reduction With TIVA • Very dramatic reduction of post operative nausea/vomiting. • Less dysphoria at wake-up. • Essential elimination of laryngospasm on emergence.

  6. TIVA Can Be Used Widely • Oxygen/air/propofol/opiates +/- muscle relaxants. • Spontaneous breathing with laryngeal mask airway is not a problem. • Need propofol pump and level of consciousness monitoring. • Sevoflurane is the preferred induction agent for small children without an IV.

  7. Vapor is the Easy Chair • Muscle relaxation included. • Awareness not a problem. • Hypertension “management.” • End tidal gas analysis ensures robustness.

  8. TIVA Workload is Higher for the Anesthesiologist • Awareness risk requires monitoring. • Higher doses of muscle relaxant required. • Blood pressure management with TIVA is a-la-carte. • Psychologically very difficult for anesthesiologists to use no vapor at all.

  9. The Future? • Short term benefits of eliminating vapor from anesthesia practice are compelling. • TIVA can be widely used. • Are there long term toxic effects of vapor and/or TIVA on children or adults? • Need prospective, controlled TIVA versus vapor clinical trial. • Need more technology to make TIVA easier to do.

  10. Conclusions • TIVA can essentially replace the use of vapor except for the important pediatric application of inhalation induction for which sevoflurane is the preferred drug. • The favorable short term side effect profile of TIVA compels me to avoid the use of vapor in my practice where possible.

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