255: Combat Anesthesia in PFC with Kevin

Last Updated: November 23, 2025

In this episode of the PFC Podcast, Dennis and Kevin discuss the complexities of using narcotics in long-term care, particularly in a military or austere environment. They delve into the importance of understanding drug metabolites, context-sensitive half-times, and the implications for patient care. The conversation covers various anesthetic agents, their effects, and the clinical considerations necessary for effective pain management and sedation during and after surgical procedures.

Takeaways:

Metabolites of narcotics can significantly impact patient care. Fentanyl infusions can provide prolonged analgesia but require careful monitoring. Midazolam has a longer context-sensitive half-time compared to other anesthetics. Morphine’s metabolite can lead to increased potency and potential overshooting. Dilaudid is preferred over morphine for its predictability in effects. Vecuronium’s metabolite can cause prolonged neuromuscular blockade, especially in renal impairment. Ketamine can have unexpected, prolonged effects postoperatively. Timing of drug administration is crucial in prolonged field care scenarios. Patients with low urine output may require adjusted medication dosages. Understanding context-sensitive half-times is essential for effective anesthesia management.