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
R – receive
A – appreciate
S – summarise
A – ask
Risk factors for increased morbidity & mortality:
- Peak VO2<15 ml/kg/min
- Anaerobic threshold <10-11 ml/kg/min
- Ventilatory equivalent (measured at AT) >35-40. Breathing hard to meet demands!