This category contains 7 posts

Tuesday morning meetings January 2013

22nd Advanced Airway Management Dr Brian Harte 29th Airway challenges in Maxillofacial surgery Dr Jane Bruton

Recovery from neuromuscular blockade

residual blockade Lesson unlearned

The value of pre oxygenation

Apnoea and preoxygenation Click the link above for the BJA CEACCP review on physiology of apnea and the value of pre oxygenation

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

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