Category Archives: Anesthesia

BIS: RELAX DON’T DO IT?

Recently saw BIS discussion re-surface. NICE recommends it, yet very few use it. We could make a long discussion about this, but the short version is we sometimes use it, despite its shortcomings. Its best use would presumably be in … Continue reading

Posted in Anesthesia | 3 Comments

NOSE CLIPS MAY NOT BE THE WAY FORWARD IN MASK VENTILATION AFTER ALL

An small but elegant experimental study in CJA explores the impact of nasal passage occlusion on mask ventilation in the unresponsive patient. Tidal volumes may be reduced by more than half when the nose is totally occluded.

Posted in Airway management, Anesthesia, Uncategorized | Leave a comment

O2 NOT NEEDED IN MYOCARDIAL INFARCTION

There’s not much left of poor MONA. We’ve written on unnecessary O2 treatment before, ie the AVOID trial. And now, one of the large RCTs on the subject is out. The DETO2X-SWEDEHEART investigators (love the acronym) have published their findings … Continue reading

Posted in Anesthesia, Cardiology, Emergency Medicine, Prehospital Medicine | 3 Comments

INTUBATION IN ARREST – AGAIN

Another study on airway management in cardiac arrest was just published in JAMA. The study was done in Denmark, where all intubations elective and emergency are done by anaesthestetists. It was a retrospective study, where they matched intubated patients with … Continue reading

Posted in Airway management, Anesthesia, CPR, Emergency Medicine, Prehospital Medicine | 8 Comments

USE ULTRASOUND FOR FEMORAL CANNULATION IN ARREST

For vascular access, you still hear the old “We don’t have time for using ultrasound – this is an emergency!”. In many settings, the old landmark techniques are quick and good in experienced hands. But when going for the femoral … Continue reading

Posted in Anesthesia, Cardiology, CPR, ECLS, ECMO, Emergency Medicine, Ultrasound | 2 Comments

CAN PLATELETS TAKE THE HEAT – OR CRACK UNDER PRESSURE?

Old dogma die hard. One of them is not heating platelets when giving transfusions. This breaks up the flow of transfusions and makes the process somewhat erratic. But the platelets are obviously heated when entering the body – the extra … Continue reading

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BCheE

I found an editorial in BJA that describes an issue with succinylcholine I wasn’t really aware of. Butyrylcholinesterase (BCheE) hyperactivity. BCheE is the non-specific cholinesterase that rapidly hydrolyses succinylcholine in the blood so that only 10% of the injected drug … Continue reading

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DIRECT LARYNGOSCOPY KILLED THE VIDEO STAR?

Videolarygoscopy (VL). Brave new world. VL makes any intubation easy, and solves airway managment problems. Well, it can be a life-saver, but it also brings its own set of problems. Two new RCTs comparing VL and DL are just out. … Continue reading

Posted in Airway management, Anesthesia, Emergency Medicine, Prehospital Medicine | 5 Comments

ULTRASOUND – FASTING FOR SURGERY

We’ve held on to our strict fasting regimes for decades. Gastric ultrasound is here to help us individualise our fasting rules a bit more. Gastric ultrasound has lots of uses, and lately it’s become fashionable to use it for evaluating … Continue reading

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PROPOFOL + LIDOCAINE = MAGIC

Propofol is a great anaesthetic – but it can cause pain on injection. This is one of the tricks of the trade: mix in some lidocaine in your propofol syringe, and the patient is pain free. Sounds like magic. Especially … Continue reading

Posted in Anesthesia | 8 Comments