sedationstation

When you go to do neuro- axial block in Dwarf pregnant remember the following   10 points: 1-Dwarf patients have higher incidence of pelvic deformities,  they have higher incidence of C/S...so prepare yourself for shift from NVD to CS 2-Many dwarf patients suffer from pulmonary compromise, so they may not tolerate supine position while awake, and they may not tolerate the fluid preloading. Fluids should be given cautiously rather than large predetermined volumes. Patient with severe pulmonary compromise should be intubated. 3-Airway is Big problem in Dwarfs. They Have difficult airway (large occiput,atlantoaxial instability) and higher incidence of aspiration(BIG uterus in small abdominal cavity).So choose elective intubation rather spinal anesthesia if  you feel that patient airway will bring troubles. 4-Vertebral column is part of musculo-skeletal deformities. They have higher incidence of spinal stenosis, and difficult spaces, and surely have higher...

Diphenhydramine as an Alternative Local Anesthetic Agent   Peter G. Pavlidakey, MD, Department of Pathology, Case Western Reserve University School of Medicine, Cleveland, Ohio; Erin E. Brodell, University of Richmond; Associate Professor of Internal Medicine, Northeastern Ohio Universities School of Medicine, Rootstown, Ohio; Stephen E. Helms, MD, Assistant Professor of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio ( J Clin Aesthetic Dermatol . 2009;2(10):37–40.) Abstract Patients who present with a history of “allergy” to local anesthetics are common in clinical practice. Injectable 1% diphenhydramine is a safe, inexpensive, and effective local anesthetic for simple dermatological procedures in patients who report “caine” allergies. Utilizing this agent permits the dermatologist to operate at the time of the initial visit and schedule a referral to the allergist for definitive sensitivity testing at the patient’s convenience. Diphenhydr...

FDA announced  that" Xigris treatment should not be started in new patients. Xigris treatment should be stopped in patients being treated with Xigris. All remaining Xigris product should be returned to the supplier from whom it was purchased'' . This announcment is based on  PROWESS-SHOCK study, now complete, showed no benefit in its primary endpoint of 28 day mortality when compared with placebo in septic shock patients. There was also no benefit in a subgroup of patients with protein C deficiency, and no significant increased risk of severe bleeding.

When you put DIC in the Differential list,be careful when you read the lab results,misleading may occur because of the following reasons: 1-Thrombocytopenia (<100,00/uL) is not always evident early in the process, but true DIC without sequential reduction in platelet count is very unlikely. 2-PT and aPTT may remain normal in spite of decreasing factor levels because of the presence of high levels of activated factors including thrombin and Xa. 3-Fibrinogen level may not be decreased, i.e., <100 mg/dL, initially. Fibrinogen is an “acute phase reactant” which increases in response to stress and the early consumption of fibrinogen may simply reduce its levels to “normal”. 4-FDPs are a sensitive measure of fibrinolytic activity although they not specific for DIC. 5-D-dimer (which is a breakdown product of the cross-linked fibrin in a mature clot) is somewhat more specific for DIC. ASA refresher courses 2009

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Magnesium Sulphate (MgSO 4 ) is the anticonvulsant of choice in preventing and treating eclamptic fits. Magnesium sulphate is usually administered as a slow intravenous bolus of 4 to 6 grams and then as an infusion of 1 – 2 grams per hour to keep the serum Mg in the therapeutic range.  MgSO 4 is a safe drug to use in the pregnant patient .However it has some drawbacks MgSO 4 may also increase the likelihood of hypotension during regional anaesthesia . It  blunts the response to vasoconstrictors. At moderately high levels it inhibits the transmission at neuromuscular junction,leading to apnea. The risk of Mg Toxicity increases with the presence of oliguria since magnesium depends the kidneys for excretion.  Normal plasma level (NB most magnesium is intracellular)   1 Therapeutic range  2 - 3 ECG changes 3 – 5 Loss of deep tendon reflexes  5 Muscle paralysis, Respiratory depression  6 - 7.5 Cardiac arrest  12

Propofol infusion syndrome is characterized by severe lactic acidosis, rhabdomyolysis and lipidemia which can lead to cardiovascular collapse. The suggested dose and duration to avoid propofol infusion syndrome in healthy patients is > 4 mg/kg/h over 48 hours. The syndrome may occur with smaller doses and duration in children with  Mitochondrial diseases.The syndrome may occur with smaller doses and duration in children with underlying disorders (200 mcg/k/min over 150 min in a 7 y.o.) Mitochondrial diseases affect ATP production and present as clinical disorders of skeletal muscle, brain and heart. Propofol has several negative effects on mitochondrial ATP production which include:  1) inhibition of enzyme activity of electron transport complex 2) inhibition of carnitine palmitoyl transferase   3) inhibition of These depressant mitochondrial effects may account for proposal infusion syndrome occurring in these susceptible patients. Mitochondrial disorder...

Increased Infection Risk 2-fold risk with 2C drop Increase in Blood Loss/Transfusions EBL increased 500 cc with 1.6C drop Increased Cardiac Morbidity NOT due to shivering, possibly arrhythmias, hypertensive response to stress of cold  . Normothermia associated with a 55% reduction in cardiac risk Increased Anesthetic Potency MAC drops 15% for every 1.0C. Vecuronium, atracurium prolonged by up to 60% Kurz A et al. NEJM 334: 1209, 1996 Frank SM et al. JAMA 277: 1127, 1997

For PICC line isertion choose the Basilic Vein (medial antecubital vein),because it has Larger diameter(8mm) compared to Cephalic(lateral) 6mm,also i has  straight course PICC have low risk of infection ,and can be left in place for 30 days PICC pneumothorax risk is Zero On the Other hand PICC have higher incidence of thrombosis,becuase of smaller diameter(2x higehr risk of venous thrombosis) PICC can be used to measure CVP,CVP recorded via PICC lines are about 1 mm Hg higher than CVP from centrally inserted venous catheters. Heparinized saline should be infused at arte of 3ml/hr,because of narrow and long course. Bonizzoli M et al. Intensive Care Med 37: 284, 2011 Central venous pressure measurements: Peripherally inserted catheters versus centrally inserted catheters - Critical Care Medicine. 28(12):3833-3836, December 2000.

Placenta accreta, an abnormally deep attachment of the placenta into the endometrium and myometrium (the middle layer of the uterine wall), complicates 3% of primary, 11% of secondary, 40% of tertiary, 61% of quaternary, and 67% of higher-order cesarean sections for placenta previa. 6 The most common risk factor for abnormal placentation is previous cesarean section, but any invasive procedure that might affect the endometrium (including curettage, hysteroscopic surgery, myomectomy, and endometrial ablation) can increase the risk. Differences in oxygen tension in abnormal placental beds have been invoked as a cause of abnormal placental invasion. It has been reported that preferential implantation of embryos into a relatively avascular scar tissue occurs because of decreased oxygen tension. 9 Although the optimal timing for delivery is uncertain, early delivery is often recommended to minimize additional risks that are associated with emergent surgery. Transcatheter arterial em...

Perioperative acute renal failure is a common complication of major surgery and is associated with increased morbidity and mortality. Ischaemia- or toxin-mediated acute tubular necrosis is the primary cause of perioperative acute renal failure. The key non-pharmacological strategies are intravascular volume expansion, maintenance of renal blood flow and renal perfusion pressure, avoidance of nephrotoxic agents, careful glycaemic control, and the appropriate management of post-operative complications. At present, there is no firm evidence to suggest that the use of any specific pharmacological intervention is clinically beneficial. Dopamine infusion has not been shown to prevent acute renal failure, avert the need for renal replacement therapy, or reduce mortality, and should not be administered solely for renal protection. Contin Educ Anaesth Crit Care Pain (2008) 8 (5): 176-180

A wide range of treatments may be prescribed by the subcutaneous route; either infusion or injection, they include: ·          Isotonic fluid replacement ·          Immunisations ·          Immunoglobulin replacement ·          Iron chelating treatment ·          Insulin ·          Heparin ·          Hormones and growth factors ·          Cytotoxic chemotherapy ·          Sedation and narcotic agents ·          Opioids: morphine     

A very helpful presentation about anesthesia and allergy just click on the the link and update your knowledge http://www.slideshare.net/doctorabouleila/allergy-and-anesthesia

Intraoperative cell salvage (ICS) is a method of scavenging blood from the operative field, allowing it to be re-infused back into the patient. The technique involves aspirating blood lost within the surgical field into a collection reservoir. Blood is mixed with an anticoagulant solution containing either heparin or citrate to prevent clotting. Indications for intraoperative cell salvage (ICS) ICS systems may be used in elective and/or emergency surgical procedures where the surgical field is not contaminated by faecal or infective matter and where no other contraindications exist. Patient selection for ICS is at the discretion of the surgeon and anaesthetist caring for the patient based on an individual risk benefit assessment . ICS indications : Patients undergoing elective or emergency surgical procedures where the anticipated blood loss is greater than 200 ml and exceeds 20% of the patient’s estimated blood volume  The main indications in the paediatric popul...

130 slides highlight the preoperative evaluation,with clinical examples just press on the link and get to know more http://www.slideshare.net/doctorabouleila/preop-evaluation-workshop-2

Serotonin syndrome is rare ,but still can occur due to drug-drug interaction in the perioperative period,like interaction between MAOI and Demerol or Tramal.So it is crucial to know about its management. Here is another strategy to treat this syndrome: If benzodiazepines and supportive care fail to improve agitation and correct vital signs, several case reports indicate the successful use of cyproheptadine, an antihistamine with nonspecific antagonist effects at 5-HT 1A and 5-HT 2A receptors. Cyproheptadine is available in 4 mg tablets or 2 mg/5 mL syrup. When administered as an antidote for serotonin syndrome, an initial dose of 8-12 mg is recommended, followed by 2 mg every two hours until clinical response is seen. Cyproheptadine is only available in an oral form, but it may be crushed and given through a nasogastric tube. Cyproheptadine may lead to sedation, but this effect is consistent with the goals of management. It may also produce transient hypotension due ...

Transdermal opioids  Patch is very useful for patients with poor oral intake and it is better in terms of patient compliance However it holds some disadvantages, 1-only one drug is available(Fentanyl) 2-increased absorption in case of fever 3-slow onset action 4-need for alternative in Breakthrough pain,(not good choice in the rapid fluctuating pain) 5-difficult to deliver higher dose

Now you can download Pediatric anesthesia Basics and Beyond presentation. 125 slides highlight  updated topics in pediatric anesthesia,and anesthesia implication for laparosopic surgery in pediatric population. Just click on the following link http://www.slideshare.net/doctorabouleila/the-basics-of-peds-anesthesia-autosaved I hope you will like it

  PONV is higher in the pediatric surgical population than in the adult surgical population. The Peak incidence of PONV in Pediatric Population is 12 +-1 years. Women  have a higher incidence of postoperative nausea and vomiting than comparably aged adult men undergoing similar procedures . Women  have higher incidences of PONV if the procedure is performed during their menses . The highest incidence of PONV occurred during the 4th and 5th day of the menstrual cycle. The gender difference does not apply to children. Watcha MF and White PF. Postoperative nausea and vomiting: its etiology, treatment, and prevention. Anesthesiology 1992; 77:162-84. Palazzo MGA and Strunin L. Anaesthesia and emesis: I. Etiology. Can Anaesth Soc J 1984; 31:178-87. Beattie WS, Lindblad T, Buckley DN, Forrest JB. The incidence of postoperative nausea and vomiting in women undergoing laparoscopy is influenced by the day of the menstrual cycle. Can J Anaesth 1991; 38:298-302.

1-Craniotomy...Risk of Brain swelling 2-Hepatectomy...Risk of liver congestion 3-TURP...Risk of TURP syndrome 4-Pneumonectomy...Risk of Post Pneumonectomy Pulmonary edema 5-Pre-eclampsia patient...Risk of Pulmonary Edema please  add more  dry surgeries .....

a 65 slides describing the every day practice in the OR.It is a helpful guide for all anesthesia residents. click on the link or copy paste it,then you will have access to the presentation and you can download it. http://www.slideshare.net/doctorabouleila/how-to-set-your-room

The left molar approach is a technique to improve the view at laryngoscopy using a standard macintosh laryngoscope. It was described by Yamamoto 1 as follows: insert the blade from the left corner of the mouth at a point above the left molars; the tip of the blade is directed posteromedially along the groove between the tongue and the tonsil until the epiglottis and glottis come into sight; before elevating the epiglottis, the tip of the blade is kept in the midline of the vallecula and the blade is kept above the left molars; the view provided is framed by the flange, the lingual surface of the blade, and the tongue bulged to right of the blade. The success of this approach in comparison with alternatives has been reproduced by others 2 . However although Yamamoto and others demonstrated that this improved the laryngoscopic view, actual intubation may still be difficult because of the limited access to the cords, in part caused by the bulging of the tongue. The take home mes...

Definite diagnostic markers of MI on the ECG are: Pathologic Q waves ST segment elevation New onset left bundle branch block (Lt BBB) Typical evolution, over time, of ST segment elevation, T wave inversion, and Q wave development in an anatomically consistent distribution on the ECG