most recent 30 from http://gasexchange.com 2010-09-07T12:40:13Z http://gasexchange.com/feeds http://www.creativecommons.org/licenses/by-nc/2.5/rdf http://gasexchange.com/questions/690/inhalational-anaesthetics-works-on-which-sites-where-are-the-receptors-what-is piyush 2010-07-01T21:28:46Z 2010-09-07T04:23:21Z

<p>sevo,des,iso how they work?</p> <p>where in the brain , brain stem ? RAS? which receptors? gaba ,nmda ? </p> <p>anybody has any idea any evidence to support?</p> <p>where where where?????/</p>

http://gasexchange.com/questions/691/failure-of-intra-articular-local-anaesthesia-after-arthroscopy DBert 2010-07-02T00:53:53Z 2010-09-07T04:23:21Z

<p>The orthopaedic surgeons I work with all use intra-articular bupivacaine (+/- morphine or magnesium) after their knee arthroscopies. This usually works well, and I give no opioid, allowing them to go home earlier. Occasionally, though, I have a patient wake up in severe pain. Other than failure to inject the local into the joint (they don't all use the arthroscopy port), is anyone aware of variants to the operation, for example lateral release, that make the intra-articular local less likely to work?</p>

http://gasexchange.com/questions/489/blood-transfusion-mortality-and-morbidity-in-cardiac-surgery Tagawa Matsuda 2010-03-03T22:07:54Z 2010-09-06T18:23:22Z

<p>When I last investigated the issue there appeared to be a large body of (non-randomized) evidence correlating allogenic blood transfusion during cardiac surgery with adverse outcomes, particularly short and long-term mortality. Additionally these associations are often referred to when considering the utility and safety of transfusion in <em>any</em> setting.</p> <p><strong>A cardiac surgeon recently challenged me on this, claiming that recent evidence refuted this association for moderate volume transfusions in cardiac patients.</strong></p> <p><strong>Has there been recent high-level evidence that suggests this change in belief?</strong></p>

http://gasexchange.com/questions/720/new-onset-af-pre-thjr brad from melb 2010-08-18T12:43:28Z 2010-09-06T06:33:27Z

<p>Today when reviewing a 56yo ex-smoker pre-THJR, I found him to be in AF at a rate of 72/min. Confirmed by 12 lead ECG. Physician review 2 weeks previously did not note AF. He was asymptomatic. Aside from being a middle aged ex-smoking male, there were no other CVD risks. Should I have continued with my usual technique of spinal/sedation/arterial line, or should I have sent him to a friendly cardiologist for review/evaluation/further investigation? </p>

http://gasexchange.com/questions/523/difficult-airway-scenario-awake-lma-insertion james 2010-03-18T15:02:39Z 2010-09-06T00:38:16Z

<p>A case of interest, maybe. Outpt knee arthroscopy with quick sports medicine surgeon (Philadelphia Eagles team doctor), usually done with GA and an LMA</p> <p>64 y/o BMI 45, with PMHx of HTN, CAD (status post CABG 2003, no SXs since) DM (less than 10 years), past hx of tobacco (25 years ago)</p> <p>ROS adeq exer tol, no SOB, no chest pain, no cardiac Sxs, denies OSA, Positive snoring denies daytime sleepiness</p> <p>PE airway, Cl 2 malampatti, FROM but with double chin, 3 fingers, teeth n good condition no prom overbite, sniffing adequate, Neck size apprx 20 inches, no other sig findings, negative prayer sign, no atlanto occipital problems</p> <p>LABS CO2 on electrolytes 32 mmol/L, blood glucose 132 mg/dL (7.3 mmol/L), no LVH</p> <p>Meds BP med which has been fairly well controlled, oral hypoglycemic</p> <p>I asked the anesthesia resident how he would do the case and he said he could probably ventilate the pt, so he would choose a mod rapid sequence. I asked the CRNA, who was actually doing the case how he would do it and he said he could also probably ventilate and would throw in an LMA. I felt I could probably vent pt too but that there might not be any second chance to intubate or place an LMA and it was an unknown factor as to how much reduntant and swollen tissue there was in the peri glottic area as I felt strongly this pt might have an element of OSA, a mildly elevated CO2 on lyte panel might mean pt is a mild retainer, and it was obvious to me that the pts FRC was much less than 2 liters probably more on the order of 200 cc.</p> <p>So we proceede with an awake FOI. I started some precedex titrating in 10-15 &mu;gs at a time, and a neb lidocaine followed by lido tongue lollipop, and the bilateral GP blocks with Lido, and bilat SLN blks with lido. I was gg to do the transtrach in the OR as is my habit. By now the pt could easily tolerate the oral airway completely without any gag. I then thought i might be able to insert #3 LMA in the holding area. We did, pt tolerated easily, so we went back to OR. Pt moved himself over to the table with LMA, we titrated in some volatile and proceeded with the case maintaining spont respers thruout. Case went really well.</p> <p>Has anyone else tried this before, and what do you think of this? We totally avoided muscle relaxation and an ETT. I just wanted to know what others think of this?</p>

http://gasexchange.com/questions/682/two-more-mnemonics-one-for-difficult-mask-ventilation-and-one-for-sudden-collap piyush 2010-06-28T09:03:14Z 2010-09-06T00:29:57Z

<p><strong>Difficult mask ventilation ( MOANS)</strong></p> <p>M-difficult mask seal</p> <p>O-obstructive symptoms ( obstructive sleep apnoea)</p> <p>A- age more than 55 yrs</p> <p>N- no teeth</p> <p>S- stiff lung( bronchospasm)</p> <p><strong>sudden collapse of a patient who is on any kind of ventilator (DOPES)</strong></p> <p>D- dislodgement ( from tube to ventilator connections)</p> <p>0 - obstruction </p> <p>P- pneumothorax</p> <p>E- equipment failure</p> <p>S- staking breaths or auto peep </p>

http://gasexchange.com/questions/666/mechanical-ventilator-setting Dr.Vijay Parikh 2010-06-17T15:49:57Z 2010-09-06T00:23:22Z

<p>What is the ideal mechanical ventilator setting in patient with <strong>METABOLIC ACIDOSIS</strong> due to any etiology.</p>

http://gasexchange.com/questions/258/has-simulation-centre-based-training-been-validated-for-teaching-in-anesthesia susanwilliams 2009-12-16T20:09:30Z 2010-09-03T02:23:33Z

<p>Over the past decade we have seen a huge amount of interest in simulation-centre training for anesthesia, resuscitation and trauma response, among other areas. There are now centres all over the world: <a href="http://med.stanford.edu/VAsimulator/" rel="nofollow">Stanford</a>, <a href="http://www.anes.upmc.edu/" rel="nofollow">University of Pittsburgh</a>, <a href="http://pennstatehershey.org/web/simlab/home" rel="nofollow">Penn State</a>, <a href="http://home.earthlink.net/~stecknk/" rel="nofollow">Cleveland Clinic</a>, <a href="http://anesth.med.utah.edu/Education/patsim/index.htm" rel="nofollow">University of Utah</a>, <a href="http://www.bmsc.co.uk/" rel="nofollow">Bristol</a>, <a href="http://www.addenbrookes-pgmc.org.uk/simcentre/courses.asp" rel="nofollow">Addenbrookes</a>, <a href="http://www.gcal.ac.uk/nmch/aboutus/facilities/clinicalsimulationlabratory/" rel="nofollow">Glasgow</a>, <a href="http://medecine.unice.fr/RepTechnologies" rel="nofollow">Nice</a>, <a href="http://www.ambu.de/" rel="nofollow">Freidberg</a>, <a href="http://www.anaesthetist.com/wad/" rel="nofollow">Johannesburg</a>, <a href="http://www.ctec.uwa.edu.au/index.aspx" rel="nofollow">Perth</a>, <a href="http://www.svhm.org.au/infoabout/education/simulator%5Fedu.htm" rel="nofollow">Sydney</a>, <a href="http://www.healthinnovation.com.au/" rel="nofollow">Melbourne</a>, and many, many <em><a href="http://www.bmsc.co.uk/sim%5Fdatabase/centres%5Feurope.htm" rel="nofollow">more</a></em>.</p> <p>My own institution is now in the process of planning a multi-million dollar centre, and I wonder whether the huge cost is justified. Is there evidence for the training and safety benefits of simulation centres versus more traditional training methods? Is this the way of the future?</p> <p><strong>I want to believe!</strong></p>

http://gasexchange.com/questions/675/hypertension-induced-acute-pulmonary-edema-anything-new-morphine-lasix-should-b piyush 2010-06-26T14:20:31Z 2010-09-03T01:23:33Z

<p>WE NO MORE DOSING THESE PATIENTS WITH ANY LASIX OR MORPHINE STILL GETTING 100% SUCCESS RATE . WE USE ONLY BiPAP 100% OXYGEN + NITROGLYCERINE BOLOUSES 400 MICRO TO 800 MICRO EACH ONE OR TWO MINUTES TILL PT SAYS HE IS FEELING BETTER OR BLOOD PRESSURE REACHES 140 TO 160 FROM 200 SYSTOLIC. AIM IS BREAK THE VICIOUS CYCLE .</p> <p>ANY ROLE OF FUROCEMIDE (LASIX) OR MORHINE ? answer is nooooooooooooooooooooooo</p> <p><strong>ANY BODY USING THIS HIGH DOSE NITRO METHOD?? OPINION?</strong>??????/</p> <p>WE HAVE BEEN TREATING THESE PATIENTS SINCE AGES WITH DIURETICS AND MORPHINE. DO YOU FEEL THESE TWO DRUS DOING MORE HARM THAN GOOD?</p> <p>here is a suggestion next pul edema patient you get - Bipap 100% o2 then start giving 400microgram nitroglycerine each min and take BP each min till you reach 140 systolic from 200 then get back to blog and tell me what happened ? waiting for answer</p> <p>??</p>

http://gasexchange.com/questions/722/higher-that-expected-insp-co2 Jeff Miller 2010-08-24T14:42:27Z 2010-08-31T05:21:54Z

<p>Cuffed or un-cuffed endotracheal tubes in children at 3 months or less in age. After taking the anesthesia machine only out of the puzzel. What would cause higher than 4mmhg Insp CO2 readings on the monitor? Thank you.</p>

http://gasexchange.com/questions/637/use-of-mannitol-to-lower-intraocular-pressure Joy Harding 2010-04-26T07:18:04Z 2010-08-30T20:23:35Z

<p>I was recently asked to give 500mls of 20% mannitol as part of an institutional protocol to lower IOP before insertion of a Molteno drain for glaucoma. I felt this to be a substantial dose for an elderly patient. I negotiated with the surgeon to give half this dose and we obtained a very satisfactory 'soft' eye. There are potential side effects with mannitol, and I feel that a much reduced dose of mannitol would be safer and equally effective. Any thoughts?</p>

http://gasexchange.com/questions/709/choice-of-inotropic-drugs beki 2010-07-18T14:50:25Z 2010-08-30T16:23:29Z

<p>i wonder which inotropic drug is 1st choice in critical patients with hypovolemic shock? please tell us the right dose &amp; infusion rate. the available drugs we have here are only dopamine and adrenaline.</p>

http://gasexchange.com/questions/711/oral-propofol-anybody DBert 2010-07-27T07:33:54Z 2010-08-29T13:23:20Z

<p>Here's a bit of a pharmacokinetic puzzle posed by a nurse, and the more I think about it, the more interested I am in the possible answer. The question was simply, "what would happen if you drank 20ml of propofol?" I'd be interested in what other people think to what could be a pretty good introductory question to the primary anaesthetic viva. </p>

http://gasexchange.com/questions/723/tourniquet-complications Marc 2010-08-26T03:57:54Z 2010-08-26T03:57:54Z

<p>What are the evidence-based guidelines for pressures used for tourniquets?</p>

http://gasexchange.com/questions/700/how-to-manage-severe-bronchospasm-under-anaesthesia piyush 2010-07-07T17:07:55Z 2010-08-24T13:23:30Z

<p>any perticular protocol to follow even if patient is in deep plane ?</p> <p>cannot ventilate situation stony hard lung ?</p> <p>patient desaturating to 75% what should be done?</p>

http://gasexchange.com/questions/419/is-cvp-actually-a-useful-parameter-to-monitor-during-anaesthesia Tana Devoy 2010-02-10T01:42:37Z 2010-08-17T18:36:09Z

<p>I do a fair number of major cases that warrant putting in a central line (or at least I've always thought they warranted it), but many of my colleagues are no longer doing so, saying that CVP is not a useful measure of blood volume. There are obviously other reasons for putting in a central line like infusing vasoactive drugs but is the practice of giving fluids to maintain a given CVP appropriate?</p>

http://gasexchange.com/questions/692/what-is-diastolic-heart-failure-and-its-importance-in-anaesthesia-what-are-the piyush 2010-07-02T10:48:21Z 2010-08-02T15:14:22Z

<p>ECHO? or</p> <p>BNP ? or</p> <p>Angio pressure? what are the anaesthetic implications?</p> <p>any details about preserved ejection fraction heart failure?</p>

http://gasexchange.com/questions/418/checking-the-cords-after-thyroidectomy Richard K. 2010-02-10T01:07:05Z 2010-07-31T17:49:47Z

<p>I recently anesthetized for a total thyroidectomy with a new surgeon who asked me to check the patient's vocal cords at the end of the case. This is not my usual practice for a thyroidectomy, though I'm aware that some surgeons have a preference for this.</p> <blockquote> <p>Is there any evidence of benefit or utility in performing direct laryngoscopy at the end of a thyroidectomy in order to confirm recurrent laryngeal nerve function?</p> </blockquote> <p>In my experience it tends to cause hypertension and risks laryngeal trauma at the end of an otherwise well managed anesthetic! I cannot imagine that whether the cords are seen to move or not at this stage offers any reliable indication of true cord function.</p>

http://gasexchange.com/questions/470/systolic-pulse-pressure-variation-for-fluid-status-assessment-isanything-bet john-dahill 2010-03-01T11:43:40Z 2010-07-24T22:23:37Z

<p>Given that the CVP emperor now provably <a href="http://gasexchange.com/questions/419/is-cvp-actually-a-useful-parameter-to-monitor-during-anaesthesia" rel="nofollow">has no clothes</a>, and there are a multitude of devices <a href="http://gasexchange.com/questions/148/any-experiences-using-the-uscom-ultrasonic-cardiac-output-monitor-or-similar" rel="nofollow">measuring continuous cardiac output</a> and various other parameters that might be used to guide intra-operative fluid management — and let's not forget the trans-esophogeal echo — has there been any demonstrable benefit of one modality over another?</p> <p>I am particularly interested in how these compare to the readily measured <strong>systolic pressure variation</strong> and <strong>pulse pressure variation</strong>, which are becoming an increasingly common (and easy!) way of guiding intraoperative fluid management.</p> <p>Any comparative evidence, especially evidence focusing on outcome data?</p>

http://gasexchange.com/questions/710/choice-of-inotropic-drugs beki 2010-07-18T14:53:25Z 2010-07-18T14:53:25Z

<p>i wonder which inotropic drug is 1st choice in critical patients with hypovolemic (hemorrhagic ) shock intra-operatively? please tell us the right dose &amp; infusion rate. the available drugs we have here are only dopamine and adrenaline. </p>

http://gasexchange.com/questions/152/what-is-the-most-effective-technique-for-performing-an-emergency-cricothyroidotom Rohan Wilson 2009-11-23T08:43:40Z 2010-07-13T02:06:55Z

<p>We all hope that we will not need to, but prepare for it regardless: <strong>the emergency surgical airway.</strong></p> <p>In a cannot-intubate-cannot-ventilate scenario, what is the best technique and most useful equipment for establishing a surgical airway - in particular a cricothyroidotomy?</p> <p>Extra points for published evidence or personal experience.</p>

http://gasexchange.com/questions/705/best-anesthesia-plan-for-morbid-obesity-surgery piyush 2010-07-12T21:38:33Z 2010-07-12T21:50:17Z

<p>what are your opinion .</p> <p>anaesthetic implications</p> <p>recent advances please</p>

http://gasexchange.com/questions/704/scope-for-mds-from-india bobby 2010-07-09T11:07:21Z 2010-07-09T11:07:21Z

<p>how is the scope in foreign countries and what are the opportunities for further study and jobs for MDs in anesthesiology from india? </p>

http://gasexchange.com/questions/698/xigris-activated-protein-c-how-many-still-think-that-it-works-is-it-a-dying piyush 2010-07-07T13:51:32Z 2010-07-07T14:53:04Z

<p>what is the evidence ?</p> <p>Enhace trial </p> <p>Prowess trial</p> <p>Address trial</p> <p>APACHE score 25 or more means patients is almost died then why to give? (SSC guideline2008)</p> <p>what does all the result says? can anybody simplify ? </p>

http://gasexchange.com/questions/699/how-imoprtant-is-therapeutic-hypothermia-what-are-the-steps-whom-not-to-cool piyush 2010-07-07T13:58:20Z 2010-07-07T13:58:20Z

<p>post arrest hypothermia how hot a topic is it?</p> <p>how do you do it?</p> <p>what are the major steps?</p> <p>what are the literatures? </p>

http://gasexchange.com/questions/693/is-there-an-optimum-peri-operative-hemoglobin piyush 2010-07-02T22:20:51Z 2010-07-06T20:50:48Z

<p>what are the transfusion triggers.</p> <p>what all you derive from 1988 jama consesus documents</p> <p>what dose it mean by CRIT trial ABC trial </p> <p>corwins study?</p> <p>vincents study? etc etc where to settle down?</p>

http://gasexchange.com/questions/695/what-are-the-best-and-most-important-4-ultrasound-guided-blocks-all-anaesth piyush 2010-07-05T05:45:57Z 2010-07-05T15:47:25Z

<p>which four are the most imp?</p>

http://gasexchange.com/questions/680/what-else-ultrasound-can-do-for-anesthesia-and-critical-care-in-future piyush 2010-06-27T22:04:26Z 2010-07-02T10:44:40Z

<p>Presently we have been using ulltrasound for nerve blocks, placement of line (CVP,art line),volume status exmination Inferior venacal index, internal jugular index, even there is a small TEE probe coming up compatable with ultrasound machine, diagnosis of pneumothorax .</p> <p>Any more present addition or future use ?</p> <p>please contribute .</p>

http://gasexchange.com/questions/688/what-are-some-new-methods-identifying-volume-status-in-criticall-ill piyush 2010-06-30T20:28:32Z 2010-06-30T20:28:32Z

<p>SOME OF THE UPCOMMING PARAMETERS ARE - Ultrasound of Inferior venacal diameter and respiratory variation of IVC. CVP will be 5 or less if there is more than 50% variability during respiration. IVC diameter normal adult is 2.25 if less then think of hypovolemia confirm with respiratory collapse AND VARIABILITY.</p> <p>ECHO VTI with resp variation and - total no increase (VTI=velocity time integral )</p> <p>PLR (passive leg rising) and blood pressure changes</p> <p>USG internal jugular visualisation and there upper limit</p> <p>what abt cardi Q (trans esophageal doppler) corrected time value</p> <p>TEE promising </p> <p>Flow based monitors are much more better than pressure monitors .in my opinion CVP will be a thing of past in near future .</p> <p>Emergency department bedside ultrasonographic measurement of the caval index for noninvasive determination of low central venous pressure. Nagdev AD, Merchant RC, Tirado-Gonzalez A, Sisson CA, Murphy MC. Ann Emerg Med. 2010 Mar;55(3):290-5. Epub 2009 Jun 25. </p> <p>Respiratory variations of aortic VTI: a new index of hypovolemia and fluid responsiveness American Journal of Emergency Medicine Michel Slama1, Henri Masson1, Jean-Louis Teboul2, Marie-Luce Arnout1, Dinko Susic3, Edward Frohlich3, and Michel Andrejak1- Volume 27, Issue 1 (January 2009) DOI: 10.1016/j.ajem.2008.01.002 </p>

http://gasexchange.com/questions/526/what-are-some-good-mnemonics-for-residents-learning-anesthesiology Steve L 2010-03-19T05:54:16Z 2010-06-29T05:49:27Z

<p>What are some good mnemonics for residents starting Anesthesiology training? </p> <p>For example, </p> <p>MUDPILES (methanol, uremia, DKA, paraldehyde, INH, lactic acidosis, ethylene glycol, salicylates) for anion gap acidosis differential. </p> <p>SOAP-IM for OR preparation (Suction, Oxygen, Airway, IV access, Monitors)</p>