sedationstation

Early continuous passive motion Avoid quadriceps paresis. Ambulatory Surgical results---KJL (patellar tendon) =Hamstring KJL more painful than "hamstring" Femoral nerve Block is not recommended for outpatient ACL reconstruction with "hamstring" graft.  (Frost S, arthroscopy 2000) Femoral block more indicated for KJL Catheters ... probably too much

The evidence regarding regional techniques compared with general anesthesia has been reviewed with respect to several outcomes. Seven studies of neuraxial block and six trials of peripheral nerve catheters that measured induction time showed an increase by 8 to 9 minutes in induction time associated with regional techniques.  Two of the studies showed that blocks performed in an induction room outside the operating room during the room turnover process could allow for the total anesthesia time to be competitive with general anesthesia. Two other studies looking at the utilization of block rooms showed actual reduction in induction time. The use of rapid-acting drugs, such as 2-chloroprocaine, and the presence of experienced anesthesiologists also appear to reduce the additional time required for regional techniques.  Nevertheless, the overall data indicate that there is greater time required for the performance of blocks and the onset of satisfactory analgesia. ...

The following videos describes     what is called “inattention blindness” or “change blindness”.  The idea is that people often miss large changes in their visual field. This has been shown in many experiments. Do you think that some errors in Anesthesia practice stem from this Blindness??

Oxygen has five "tasks" in the AGM ; it powers the ventilator driving gas flush valve oxygen pressure failure alarm oxygen pressure sensor shut-off valve ("fail-safe") flowmeter It also plays a role in the hypoxic guard system, which maintains the correct proportion between flows of oxygen and nitrous oxide.                                            Click on the photo below

The evidence regarding regional techniques compared with general anesthesia has been reviewed with respect to several outcomes. Ten studies of neuraxial blockade showed no decrease in postanesthesia care unit (PACU) time, or in the rate of PACU bypass, probably related to the persistent immobility associated with neuraxial anesthesia in the early recovery phase. In contrast, peripheral nerve blockade allowed for earlier discharge from phase 1 PACU, as well as a higher percentage of eligibility to bypass phase 1 at the end of surgery. Both neuraxial blockade and peripheral nerve block were associated with significantly lower visual analog scale (VAS) scores in the PACU, as well as a significantly reduced requirement for postoperative analgesics in the PACU. Despite better pain relief, as noted previously there was no difference in the PACU time with neuraxial blockade. With neuraxial blockade, there was a 40% reduction in nausea associated with neuraxial blockade, but this wa...

Flow–volume loops measured before Lap cholecystectomy (left ) and on the first postoperative  day after coaching and pain medication (right). The shift to the right indicates a fall in lung  volumes.  The smaller, but similarly shaped, loop indicates a restrictive process.

The arterial duct is one of the fetal shunts and is closed in 3-4  days in 90% of term and ‘well’ premature babies.  The duct closes  in response to a rise in oxygen tension after birth and a fall in  circulating prostaglandins.  Patent ductus arteriosus (PDA) is  seen in 50% of VLBW infants due to low oxygen tension,  continuing high prostaglandin levels, or abnormal stimuli such  as acidosis and expansion of the circulating volume. Aorto-pulmonary shunting though the PDA causes high  pulmonary blood flow, worsening RDS, cardiac failure and low  diastolic pressure.  PDA is a risk factor for intraventricular haemorrhage, necrotizing enterocolitis and CLD.  PDA typically  becomes symptomatic at 5-10 days as pulmonary vascular  resistance falls; it presents with worsening respiratory function,  bounding pulses, a continuous murmur and chest radiograph  that shows cardiomegaly and increased lung s...