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Alcohol
Published in T.M. Craft, P.M. Upton, Key Topics In Anaesthesia, 2021
Conduct of anaesthesia. A rapid sequence induction is performed. Regional anaesthesia may not be feasible because of lack of co-operation. Peripheral neuro-pathy must also be considered. The sedative effects of alcohol are additive with barbiturates. In chronic abuse, no effect on the pharmacodynamics or pharmaco-kinetics of thiopental was observed. MAC of volatile anaesthetics is reduced in the intoxicated patient. An increased volume of distribution may increase requirements of muscle relaxants, but not if there is profound muscle atrophy. Diminished pseudocholinesterase is not a clinical problem, however electrolyte disturbance can potentiate non-depolarizing blockade. Thermoregulation is impaired and warmed fluids and a forced warm air blanket should be considered.
Preanesthetic evaluation
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Essentials of Anesthesia for Neurotrauma, 2018
Julia Martinez Ocón, Ana Ruiz Pardos, Ricard Valero
With respect to neuromuscular blocking agents, the choice for rapid sequence induction lies between succinylcholine and rocuronium. Succinylcholine increases ICP without significant side effects, so it is recommended in TBI cases where the patient has airway difficulties.
Muscle relaxants
Published in Daniel Cottle, Shondipon Laha, Peter Nightingale, Anaesthetics for Junior Doctors and Allied Professionals, 2018
Can provide rapid intubating conditions and therefore has a role in a ‘modified’ rapid sequence induction. The drug is relatively non-potent and therefore a large amount is required. The large quantity results in a large concentration gradient between the plasma and the NMJ, resulting in a fast onset of action.
Anesthetic management of obstetric patients with COVID-19: A scoping review
Published in Egyptian Journal of Anaesthesia, 2022
Radwa Hamdi Bakr Mohamed, Waad Al-Ghamdi, Aldanah Al-Marri, Bayan Al-Abdullah, Nebras Al-Hajji, Alkawthar Al-Shaybe
Although most articles recommended the use of neuraxial blockade techniques as a first-line choice for patients with COVID-19 (18 articles out of 19 articles), certain cases may present where regional anesthesia is difficult such as in case of scoliosis or obesity or in case of a poorly functioning labor epidural or in emergency cesarean section. In these, cases rapid-sequence induction and intubation by an experienced anesthesiologist using a video-laryngoscope is recommended after pre-oxygenation with 100% oxygen. Adequate depth of anesthesia should be ensured, and the maximum dose of a neuromuscular blocking agent should be administered to avoid coughing during intubation. Additionally, manual mask ventilation should be avoided, and the distribution of contaminated aerosol should be limited by extubating under an acrylic transparent box or clear plastic drapes after clamping the ETT. [1,5,13] Lee et al., (2020) and Trikha et al., (2020) further recommended that, when applying manual positive pressure mask ventilation, smaller tidal volumes should be used [2,4].
Twelve tips to maximise medical student exposure during surgical placements
Published in Medical Teacher, 2021
Usman Raja, Mohammad S. A. Amin, Ahmed Soualhi
It is easy to forget that the surgeons are not the only doctors in the room - without anaesthetics, modern surgery would not be possible as the two fields directly affect each other. Unfortunately, undergraduate anaesthetic training is often underplayed and highly variable between medical schools, despite containing a diverse number of highly relevant topics (Smith et al. 2018). So it might be a good idea to conduct your own learning to understand what exactly your counterparts do! (Patel 2018) The true value of learning from anaesthetists is getting familiar with perioperative management and physiology, and when paired with surgical rotations, the overall understanding is significantly improved (Patel 2018). Anaesthetists are always willing to teach students but might require some prompting. Consider asking about the triad of anaesthesia (analgesia, sedation, paralysis) and their methods for putting the patient to sleep and waking them up. Most surgeons have a leading role in managing trauma patients for which you might need an anaesthetist’s help to perform a rapid sequence induction, so you might want to ask about that too.
Success of Pediatric Intubations Performed by a Critical Care Transport Service
Published in Prehospital Emergency Care, 2020
Sriram Ramgopal, Sean E. Button, Sylvia Owusu-Ansah, Mioara D. Manole, Richard A. Saladino, Francis X. Guyette, Christian Martin-Gill
Of note, use of induction and NMB was associated with a higher odds of successful ETI. Cardiac arrest may have partially operated as a confounder with respect to induction, as patients in arrest are typically not induced prior to ETI. However, we obtained similar results in a model developed after exclusion of cardiac arrest, further supporting the independent role for induction and NMB in ETI success (results not shown). Use of medications for rapid sequence induction prior to ETI is associated with greater success in adults in the prehospital setting (38, 39). For patients in our study without cardiac arrest, this finding represents an important modifiable risk factor for patients requiring rapid sequence intubation. Further training to prehospital personnel on use of induction agents for pediatric rapid sequence induction for intubation may be associated with improved outcomes.