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 happ …

In our facility in non-cardiac surgery the first-line vasopressor is norepinephrine, whereas during cardiac surgery phenylephrine is used. What could be the rationale behind this c …

We have just added Intralipid (10% lipid emulsion) to our resuscitation trolley at my maternity hospital for use in the resuscitation of local anaesthetic toxicity. We were mainly …

Hi, I've been told that rocuronium has a much higher rate of anaphylaxis than other muscle relaxants? Is this true? If so, why do we use it?

The rep for a competing formulation of propofol has just left. He wishes us to embrace his formulation of propofol, claiming a reduction of pain on injection from 60% to 38% but at …

Here's one for the history and trivia buffs: how was propofol first formulated? For extra points, when and where was the research conducted that investigated how to formulate prop …

I've just heard about the new platelet inhibitor Prasugrel but don't yet know much about it. It sounds like it's from the same family as clopidogrel. Is this correct? Are there any …

I was working with a senior anaesthetist the other day, and one of our patients was very slow to wake. My senior colleague asked me whether I thought flumazenil would help. What i …

I know what makes heavy (hyperbaric) bupivacaine heavy, the 80 mg/mL of glucose that is added - and I know why the glucose is added, causing the local anaesthetic to 'fall with gra …

One of the arguments from anesthetists using nitrous oxide for anesthesia maintenance is the increased uptake of the volatile due to the second gas effect. However I sense some deg …

All this talk of sugammadex, rocuronium replacing sux, and the contraversy of rocuronium anaphylaxis has me wondering - is suxamethonium really that bad? What are the side effects …

I have just restarted doing cardiac anaesthesia after a break of a few years. We used to use aprotinin very commonly to reduce blood loss but when I went to make up the infusion I …

Having just returned to practicing cardiac anesthesia, I was wondering about new drugs in the field and have come across levosimendan. When should this drug be used and how is it b …

It seems to me that sevoflurane is better than any of the other volatile agents. Is there any advantage to using any of the others?

I often use remifentanil during major cases for the outstanding wake-up characteristics you get with a suitable bolus of fentanyl or morphine at the end of the case. I've found pat …