Useful infographic from BMJ
For procedures up to (max) 2 hours duration.
Quicker recovery than bupivicaine making it suitable for day-case
3.5ml of 2% hyperbaric prilocaine +/- 20mcg fentanyl
Saddle block: 0.5 – 1.0 ml
> T10 block: 3+ ml
< T10 block: 2-3 ml
Perspective from The New England Journal of Medicine — What Is Value in Health Care?
Keep dry – almost no fluid prior to resection. CVP <5
Then catch up
A-line, CVC, +/- swan sheath
Consider iVC compression by surgeons if hypotensive
Muscle relaxant (consider infusion)
- thoracic epidural
- spinal diamorphine, wound infusion catheter (2.5mg/ml levo-bupivicaine @ 10ml/hr) + morphine PCA – caution (with liver impairment)
- role for ESP block?
Excellent editorial in the journal Anaesthesia casting comparison between high pressure high stakes environment of NASA and healthcare delivery.
Useful online educational resource for ICU covering, amongst other things, ECMO and echo.
Loading dose: 50mg/kg
NB will potentiate neuromuscular blockade