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Visit the Ether Dome

I hope our recent Anaesthesia History session inspired some interest in the noble (and not so noble!) origins of our speciality.  The ‘Ether Dome’, where WTG Morton first demonstrated ether anesthesia to an audience of doctors and medical students is a real place, is essentially unchanged since October 16th 1846, and is a must-see for … Continue reading

NAP4 report on airway catastrophes

Have you had a highly challenging airway situation in the ICU or the emergency department?  Did it lead to a major adverse event?  If so you are not alone, as the NAP4 report demonstrates: http://www.rcoa.ac.uk/index.asp?PageID=1089 Although there is no denominator, and a direct comparison with operating theatre events was not a purpose of the report, … Continue reading

Western Anaesthesia Meeting is Nearly Here

This year’s Western Anaesthesia Symposium (the “Galway Meeting”) will be held in the Radission Hotel in Galway on March 2nd and 3rd. This year most of the sessions will be interactive – using audience response systems. In addition you will be able to text in questions for the experts on the panels. There will also … Continue reading

Acute Respiratory Distress in the Recovery Room (tutorial)

Clinical Scenario: A 57 year old male undergoes upper abdominal surgery. He refused an epidural. The intraoperative course was uneventful. He was given 2mg hydromorphone in the OR. He was extubated, breathing 360 ml tidal volumes; arousable. Shortly after arrival to the recovery room, the patient develops acute respiratory distress. His respiratory rate increases to … Continue reading

Agitation and Pain in the Recovery Room (tutorial)

Problem: A 43 year old male returns from the operating room following cholecystectomy. The operation had been originally planned using the laparoscopic approach. However it became necessary to convert to an open procedure. Intraoperatively the patient received fentanyl 300mic/g, propofol, vecuronium, oxygen and desflurane and cefazolin. At the end of surgery, neuromuscular blockade (sustained tetanus … Continue reading

Common Questions Regarding Stewart Approach to Acid Base Chemistry

I receive a lot of emails from confused doctors regarding the modern (Stewart) approach to acid base chemistry. A common question relates to the relative quantity of hydrogen/hydronium and hydroxyl ions. For example, if chloride is dissolved in water there is a net increase in hydrogen and a net decrease in hydroxyl. Where does the … Continue reading

Vasopressors for Hypotension During Cesarean Delivery Under Spinal Anesthesia

Anesth Analg. 2012 Feb;114(2):377-90 Vasopressor use during neuraxial anaesthesia/analgesia is more prevalent today than ever before. It is my impression that phenylephrine has emerged as the defacto pressor of choice over the past decade.  However, in 2001 95% of consultant anaesthetists used ephedrine exclusively (Burns Anaesthesia 2001). What has changed over that decade? A series … Continue reading

Perioperative Single Dose Ketorolac to Prevent Postoperative Pain

Anesth Analg. 2012 Feb;114(2):424-33 I have been a sceptic of meta-analyses, for many years. The purpose of these studies is to take a large volume of literature; both published and unpublished, and test hypotheses. The idea is to replicate a large randomized controlled trial by combining many studies together.  Unfortunately, rather than coming up with … Continue reading

Perioperative Visual Loss

Nothing terrifies an anaesthetist as much as the prospect of a patient waking up blind. It happens, but very infrequently. Who is at risk? What surgeries? What are the risk factors? Is there anything we can do to prevent and treat visual loss? Perioperartive visual loss is associated with posterior ischemic optic neuropathy (ION), anterior ION, … Continue reading

ASA Periopeative Pain Guidelines

The ASA has issued guidelines for acute pain management in the perioperative setting. Click on this link to read guidelines. Obviously there is a North American flavour to these guidelines, but they are generalisable. Summary: 1. Institutional Policies and Procedures for Providing Perioperative Pain Management Anaesthetists offering perioperative analgesia services should provide ongoing education and training … Continue reading