This category contains 27 posts

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 The purpose of these studies is to take a large volume of literature; both published and unpublished, and test hypotheses.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

Local Anaesthesia Toxicity (tutorial)

Patrick Neligan, Consultant in Anaesthesia & Intensive Care, Galway University Hospitals (c) Clinical Scenario A 37 year old female undergoes bilateral mammoplasty. The procedure is performed under general anaesthesia. Prior to incision the wound was infiltrated with 20ml of 1% lignocaine, on each side. Intraoperatively the patient’s temperature was 37.5 degrees celcius, heart rate was 100 … Continue reading