1 part jelly
1 part lignocaine spray (10%)
= 5% lignocaine
Apply to inflated cuff, then deflate
extubate fully awake but ETT tolerant without coughing on ETT
intra-op can be less deep, epecially with good going regional e.g. caudal
EdM @ LRI
Does it need to be done now? If deferred is the outcome likely to be different/better/worse/the same?
If surgically patient needs to be done but needs a level x bed and none available – if on balance the surgeons agree that, though not ideal and increased chance of mobility/mortality without higher level is recognised, if the outcome is still likely to be better than if deferring – proceed.
Have same set up for lines, monitors, etc, every time so that when things change this is constant, and when you need to respond quickly you know where things are, because there are always there.
On one port of CVC line attach a 20cm or 50cm extension so that it is way away from neck so you can easily access it without needing to rummage under drapes.
Lignocaine 1-1.5mg/kg IV or topical
Pre-med with benzo/midaz (for LMA)
Anticholinergics (reduce secretions)
Used to stablise shocked, vasoplegic patient with necrotic bowel intraoperatively.
Mechanism of action as free radical scavenger?
Dose (as for methaemoglobinaemia):
1-2mg/kg IV over 5-10min. Repeate PRN after 1 hour.
Other uses: Ifosfamide-induced encephalopathy, cyanide poisoning
Single-breath vital capacity inhalation induction with high concentration sevoflurane (SBVC – HC)
Does exactly what it says on the tin.
Prime the circuit with 8% Sevo with >= 6 L /min O2 (+/- N2O).
Hold face mask against surface to build up Sevo.
Practice vital capacity breathing with patient.
Following forced expiration apply face mask and instruct to take vital capacity breath.
Induction complete in 50-60 sec.
– PB @ LRI
J. Larsson et al (BJA, 2013) say he/she is:
- structured, responsible and has a focused way of approaching tasks
- clear and informative, briefing the team about the action plan before induction
- humble to the complexity of anaesthesia, admitting own fallibility
- patient centred, having personal contact with the patient before induction
- fluent in practical work without losing overview
- calm and clear in critical situation, being able to change to a strong leading style
A.F. Smith et al (BJA, 2011) found the most highly ranked attributes were:
- ‘strives for excellence’
- good communicator
- clinical skills
standard NIBP used on forarm has been validated for use in obese patients
Prepare parents for all eventualities, pause, say ‘its normal’
Premed if needed: midazolam 0.5mg/kg (up to 20mg) oral
1. hold mask with one hand, occiput with other
2. position parent and have plan for how to get onto trolley