Manu B

What‘s the surprise ?

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I understand . Classic LMA is my default in the kind of scenario you mentioned ( difficult airway with failed B&M ) .

Done it but with a smaller size classic LMA .

How did they come to the conclusion it’s safe to continue ACE inhib & ARB’s on the day of surgery ?

Likewise , Awake CEA ‘s & Neck dissection with flap are the MC causes of LA toxicity i’ve seen.

Easy for anyone to pass comments in hindsight .

M&M’s at hospitals I work don’t have the anesthetist directly involved with the incident presenting . Whoever is chairing the meeting usually presents & there’s no mention of the names of the anesthetist , surgeon . Supposed to a safe , blame free environment focused on discussion for learning .

😢

Refusal of an NG by someone who’s about to undergo a laparotomy for SBO is a difficult place to be in ,as an anesthetist ( & /or surgeon ) .

used It when opioid free anesthesia was a fad for a while .Didnt continue with it . Some colleagues continued using it for abdominal surgeries but I don’t think anyone’s doing it any more ? Now use small lignocaine bolus before propofol . Also for minimizing coughing on extubation for c spines .

Same here .

Ok that’s interesting .

Do you ever see muscle rigidity with such bolus doses of Remi & if so what do you do then ?

Pete , I don’t do IFT & don’t know anyone that does . Maybe I should .

I would add “ detect / prevent with IFT in paralyzed & look for response to commands in anesthetised patients who are not paralyzed ”.

Infraclavicular Subclavian was my default before USG . I haven’t done any in 20 yrs but I don’t think I’ve lost that skill . IJ is easier with USG so have defaulted to that .

IJ is my go to & USG the basic minimum std for a CVC .The exceptional circumstance you gave the only reason I mentioned landmark SCV as I feel based on my experience & skills ,I’d be losing precious time scouring for great veins with USG . Can’t comment on others opinion on this.

But I wouldn’t advise it to anyone who’s never done a subclavian using landmark technique .

If ever have to put a cvc in a rapidly exsanguinating haemorrhage ( never had to ) I would go for infraclavicular subclavian using landmark technique as it’s probably the only patent , easily accessible central venous access .

Never heard of cvc as an essential resus device .

Can I ask why the VL failed . Was it tube delivery where the problem was?

I still look at the ASA & DAS algorithms . Vortex model is a cognitive aid that tells you what the Goals are . It’s not telling you what to do .

hypothetical situation where I’m unable to intubate , bag & mask to maintain alveolar oxygenation but can achieve the same through a SGA ( reached green zone ) then I would delegate someone to look at ASA or DAS to tell me what to do next .

I still look at the ASA & DAS algorithms . Vortex model is a cognitive aid that tells you what the Goals are . It’s not telling you what to do .

That’s good . For me it was post vortex & what changed ( for me ) was being able to avoid fixation errors
( eg go back to bag & mask / getting to green zone ) and priming for CICO rescue . Avoids the E Bromley type situation outcome .

a cricket player wearing sunglasses and a white shirt is giving a thumbs up . ALT: a cricket player wearing sunglasses and a white shirt is giving a thumbs up .

Yes

* Rapidly escalating high pressure situation .

Also Anes nurses find it a lot easier
( to help us ) than DAS algorithms .

Its is a cognitive aid & that’s what’s needed in an airway crises to avoid fixation errors . Don’t ever recollect anyone reading out a DAS algorithm in my 23 yrs in anesthesia during a dynamic , rapidly evolving situation such as an airway crises .