Category Archives: fundamentals

AFOI topicalisation

1. Glycopyrolate 200-400mcg IV/IM ASAP
2. Sedation EARLY

Topicalise:
Spray co-phenylcaine to nostrils
Gargle 4x5ml of Instilagel
Spray Xylocaine (10% lignocaine) to oropharynx -> distally

+/-
Spray-as-you-go with epidural catheter (2ml 1% lig)
Cricothyroid puncture (2ml 1%lig)

Alternatives/adjuvants:
Instilagel+soft NPA to nostril NB risk of bleeding -> bad view/problems
4% lignocaine squirt to nostril using teat
4% lignocaine squirt to oropharynx
‘nebulised’ lignocaine using cannula + 1% lignocaine

 

Remifentanil recipe II – mcg/kg/min

PHASE CONTINUOUS IV
INFUSION OF ULTIVA (REMIFENTANIL)
(MCG/KG/MIN)
INFUSION DOSE
RANGE OF ULTIVA (REMIFENTANIL)
(MCG/KG/MIN)
SUPPLEMENTAL IV
BOLUS DOSE OF
ULTIVA (REMIFENTANIL) (MCG/KG)
Induction of Anesthesia (through intubation) 0.5 – 1*
Maintenance of anesthesia with:
  Nitrous oxide (66%) 0.4 0.1 – 2 1
  Isoflurane (0.4 to 1.5 MAC) 0.25 0.05 – 2 1
  Propofol (100 to 200 mcg/kg/min) 0.25 0.05 – 2 1
Continuation as an analgesic into the immediate postoperativeperiod 0.1 0.025 – 0.2 not recommended
*An initial dose of 1 mcg/kg may be administered over 30 to 60 seconds.

Anesthesia, Maintenance

0.25-0.5 mcg/kg/min IV; may bolus with 0.5-1 mcg/kg q2-5min in response to light anesthesia or transient episodes of intense surgical stress

Conscious Analgesia

1 mcg/kg IV bolus, followed by 0.05-0.2 mcg/kg/min IV

Analgesia, Immediate Post-Op Period

0.025-0.2 mcg/kg/min IV

Laparoscopic hypercarbia

Increase MV 12-18L/min (preemptively):

High RR (compared to Vt)

High I:E. Adv: reduced peak airway pressure for a given Vt, permits higher MV. (Improved oxygenation due to increased mean airway pressure.) Dis: reduced CO due to increased mean airway pressure, in obstructive airways can lead to gas trapping.
If oxygenation not a problem then reduce PEEP to increase MV for same peak airway pressure
Consider largest possible ETT.
Ask surgeons to deflate if necessary