For patients undergoing laparotomy in which epidural is desired but unsuccessful a Plan B is:
Spinal – (lower dose) bupivicaine + up to 1.5mg diamorphine
+ regional e.g. rectus sheath block / TAP block / wound infusion catheter
+ morphine PCA
Needs HDU/crit care post op
Seemed to work well
VJ @ LCH
If C-spine injury is suspected then Plan A use a technique of McCoy blade + bougie with the aim of just seeing the arytenoids to guide the bougie i.e. do not aim for a ‘grade 1’ view. This approach reduces unecessary cervical spine traction and movement.
– JH, QMC
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
If it is down the right main bronchus (which it usually is)…
Cut off the distal connection of suction tubing and pass down the ETT/tracheostomy (size 8+)
Also a possibility is to connect to oral ETT and advance into right main bronchus
This gives wide bore suction.