💉Remifentanil and Ketamine

August 07, 2020 - 7 min read 🍵🍵🍵🍵

Tags: lifebiochemistry

Disclaimer: This post is strictly for informational purpose and contains the contents of my personal story and experience. The information on medications written here by no means serves as medical advice, please consult your own professional healthcare provider.

Self Reflection

You never know when life will decide to make you fall flat on your face.

At the start of my developer journey, I had prepared myself for many obstacles, including how to program, how to learn more efficiently and learning how to manage my time effectively. I had my plans and laid everything out.

Unfortunately, I ran into an obstacle I had not planned for. I had an unexpected health issue that had left me in crippling pain. It was an infection that caused me pain when I sat down, when I walked and even when I was laying down.

It was the first time in my life that I have ever experienced a panic attack during my recovery at the hospital. I remember having shortness of breath, my entire lungs felt tight and I experienced a tingling feeling spreading through my chest to the edge of my fingers.

I was discharged from the hospital 3 days later. I had multiple visits to a nurse clinic for wound care every week, with each visit taking a bit of my soul and energy during the pain I had endured. After 5 months of dealing with the pain and antibiotics, I had felt mentally exhausted and beaten.

Lessons Learned

  • You can never prepare for life events
    • No matter how well you have laid out your plans, you will need to deal with things that are completely outside of your control.
    • Control what you can by controlling the narrative.
    • Your mind is the most important tool that you can control, so take advantage of how to think optimistically.
    • Do not let your adversity define what you cannot do.
  • Taking ownership and responsibility
    • My blog played an important role in this category.
    • When I wrote about my experiences, I took ownership of my journey.
    • When I wrote about my progress with programming, I took responsibility and accountability for my actions.
    • Writing provided me with clarity and focus.
  • Develop the proper habits
    • Reduce the friction of being able to do the task you want to do.
    • Find ways to continuously improve your process.
    • Start small and develop processes in place that make your systems robust to external change.
    • Reading books kept my mind busy and improved my ability to concentrate.

Third Post Surgery

I slowly drifted in and out of consciousness to the sound of my heart monitor beeping. I felt like I was in complete bliss, my mind was completely disconnected from my body.

With the drugs still running through my system I went back to sleep and woke up 30 minutes later being wheeled into another section of the hospital feeling a little more awake.

I remember the nurse reading me the papers for post surgery recovery and he told me something that I will never forget:

Take the pain medication as needed. Don't try to be a hero.

🧠


Wait... how did he know I tried being a hero? Who told him?!

During my second surgery, I skipped my painkillers post surgery because I felt really good and didn’t think I needed it.

I remember my pharmacist telling me that I should take it even if I feel like I don’t need it yet because the drugs from post surgery will wear off and I’ll be in pain.

I didn’t listen because I felt fine and thought I could do without it. I hated the feeling of being drowsy and I had already taken so many opioids I just wanted to take a break from it.

That next morning, I paid for it dearly…

I woke up in so much pain that I couldn’t even walk. I collapsed to the floor and crawled to my nightstand to reach the prescribed Tramacet, and while I was crawling like an idiot, I hear my pharmacist’s voice replaying in my head.

I guess it was just a coincidence that the nurse had told me that… but I thought it was kind of funny considering that I had in fact tried playing the “hero”.

I poorly misjudged my ability to handle pain, especially a day post surgery and I did not make the same mistake this time.

Remifentanil and Ketamine

I am crossing my fingers that this will be the last and final surgery for this problem. I really hope the third time is a charm and I will not be looking forward for another one.

Before my surgery, the anesthesiologist walked me through the steps and procedures and asked if I had any questions. I was genuinely curious as to what he was going to give me to make me sleep and he told me it was a mixture of remifentanil, propofol and ketamine.

I wrote about propofol and was curious about remifentanil and ketamine.

What is Remifentanil?

It is a potent short-acting synthetic opioid analgesic drug given to patients undergoing surgery[1]. It is used as a supplement general anesthesia during induction and maintains analgesic during anaesthesia.[4]

Remifentanil is approximately twice as potent as fentanyl and 100-200 times as potent as morphine👀.[2]

It has a synergistic effect with propofol meaning that it makes it very effective for anesthesia.[3]

How does it work?

It binds to mu-opioid receptors, which reduces the activity of the central nervous system reduce pain[1]. It effectively blunts haemodynamic responses to stimuli during anaesthesia.[4]

What is Ketamine?

Ketamine is a fast-acting anesthesic and painkiller that is excellent for short-term medical procedures.[5]

It has been a well-established drug that has been in use for over 50 years.[6]

How does it work?

Ketamine works by interacting with NMDA (N-methyl-D-aspartate) receptors, opioid receptors, monoaminergic receptors, muscarinic receptors and voltage sensitive calcium ion channels.[7]

By blocking the NMDA receptors, it induces a state called dissociative anesthesia which distorts perceptions of sight, sound and generate a feeling of detachment from the mind and body.[8]

It does not act on GABA receptors like other general anaesthetic agents like propofol and is administered either IV (intravenous) or IM (intramuscular) injection.[9]

Conclusion

I guess the ketamine made me feel pretty awesome. All in all, I would rate my comfort level post surgery to be 10/10 but the entire health journey to be 0/10. Life taught me a tough lesson and I hope to never go through this again.


A blog by Kien