Last week’s discussions in the CRNA forum delved into practical continuing education (CE) options that enhance both clinical and compliance skills. Members actively exchanged insights on effective opioid-sparing strategies in perioperative pain management, reflecting a growing interest in multimodal approaches. Additionally, there were lively debates on the implications of ketamine use in patients on SSRIs and how this combination can affect BIS monitoring.
This Week’s Hot Topics
Looking for CE on opioid-sparing perioperative pain
There’s a strong interest in finding CE courses that offer practical opioid-sparing techniques, which is crucial as the industry continues to prioritize patient safety and effective pain management. Read more here
CE that tightens protocol compliance
Members are exploring CE options that help enhance protocol adherence, an essential part of maintaining high standards in practice. This discussion could be beneficial for anyone looking to ensure their practice aligns with the latest guidelines. Read more here
Ketamine on SSRIs makes BIS chatty
The conversation around ketamine use in patients on SSRIs is gaining attention, especially regarding its impact on BIS readings. This thread could be useful for those interested in pharmacological interactions and patient monitoring. Read more here
Looking forward to seeing more of your valuable contributions and discussions in the forum this week.
And on ketamine with an SSRI, my BIS often looks like it had an espresso, so I don’t chase it — ‘watch the EMG and clinical signs’ and lean on MAC/EEG waveform; a small propofol or dex bump usually calms the sympathetic noise. Caveat: if they’re paralyzed and the EMG/SQI are clean, the BIS trend becomes useful again.
On SSRI patients, a ketamine bump can make BIS act like a car alarm in a thunderstorm; I set smoothing to 30 s and track SEF95 with the EMG trend instead. If I still want reassurance on TIVA, a tiny dexmedetomidine drip (0.2–[redacted]/kg/hr) steadies things better than extra propofol, but I watch for bradycardia in the elderly — @NoraCRNA, this has kept me from number-chasing.
When BIS gets jumpy with ketamine in an SSRI patient, I switch to raw EEG, watch SEF95 with the EMG trend, and set smoothing to 15–30 s; a tiny propofol tidy-up often calms the EMG. @greg_f76 is right about lead placement — I also prep the forehead with alcohol and wait 30–60 s for the Quatro to really stick before the Bair Hugger heats up. Caveat: strong artifact filters can lag, so I lean on MAC and clinical signs instead of chasing the number.