AT OUR FACILITY SOME CRNA’S HAVE BEEN PUTTING IV BAGS IN THE FLUID WARMER/BLANKET WARMER TO WARM THE IV BAGS THE TEMP ON THE WARMER ARE SET FOR 105 DEG ADMIN NOW ARE SAYING NOT TO DO THIS ANY LONGER THE REASONS ARE THE PLASTIC BAG PARTICLES COULD GET IN BAG FROM BREAK DOWN FROM HEAT ALSO WE WILL NOT BE ABLE TO DETERMINE ACTUAL TEMP OF FLUIDS ANY COMMENT OR SUGGESTION ON THIS DEAL THE FLUID WARMERS ARE MADE BY AMSCO AN
I find it difficult to wade through many of the abstracts, since they don’t apply to my practice (solo, office-based, outpatient plastic surgery center). I would appreciate it if you could find a way to combine relevant topics each month, as you did in Sept 2009 with the PONV topic. That way we could choose to skip the topics that are not relevant to our practice/interests, and concentrate on the topics that are important to us. When you combine so many different topics in one series, I find it difficult to slog through or skip specific articles and pass the CEU test.
Maybe one month could be “outpatient surgery”; next could be “trauma management”; next could be “PONV issues”; next could be “OB”….. you get the idea. That way I could choose to skip the OB abstracts since I have no interest in this topic. We’re not all generalists. Many of our practices are specific.
I also read this interesting set of case reports and have two comments:
1) Among the most commonly used drug classes in anesthesia, neuromuscular blocking agents have the highest reported incidence of anaphylactoid/anaphylactic reactions. (Not antibiotics as many believe.)
2) i recall that both of the patients in this report were taking spironolactone, a potassium-sparing diuretic. The authors do not report their pre-op K+ levels. Could the slight increase in K+ (0.5 to 1.0 mEq/L) associated with SCh have partially contributed to these events? . . . hyperkalemic cardiac arrest?
The recent 3 articles abstracts on lipid therapy for local anesthesia toxicity were interesting. I hope I never have to us lipids for LA toxicity, though it’s nice to know it is available. I am amazed at the abstract by Ludot,et al,. on using a Lumbar Plexus Block (LPB) for knee surgery on a 13 yr old. First, it stated that the patient was anesthetized with general anesthesia and then the block was performed. As you know LPB is an advanced block and should never be performed under general anesthesia for lots of reasons includng nerve injury; as simple femoral/sciatic under sedation would have sufficed. Second, I am pussled at the choice of 0.75% Naropin. Since the LPB was used for analgesia the 0.75% naropin is a much greater concentration than is needed for postoperative analgesia.
The second article by Litz, RJ -I was surprized that infraclavicular block (ICB)was used for should surgery- do you or any of the editors have experinece using ICB for shoulder surgery? Mark A. Williams, CRNA ,MS, FAAPM, CMI III
I work at ST Jude Children’s Research Hospital part time. We put these kids to sleep with Propofol many times a day. We use it for Radiation therapy, LP,LPIT, MRI, CT, Dressing Changes, Bone marrow aspiration, Inserting lines in IR, and anyhting else. We do not let these kids suffer! We call it TIVA. We either hand bolus, bolus thru the pump (1000mcg/kg/min), and maintain at 250mcg/kg/minute via pumps. Sometimes we go up or down on dosage as the vital signs reveal. We always monitor, ETCO2, SAO2, BP, RR, and Sometimes EKG. This is a standard format that has been safely used for many years. On the shorter cases we just hand bolus.
Works well and safe.