Questions related to Anesthesiology
Beyond the events on October 16th, 1846 ("Ether Day"), which stories are worth to be recognised about the history of Anesthesiology? Which are the most impressive, curious, or funny things we should remember?
Is there a current consensus on the causes of postanesthesia (IV) shivering? Based on a quick scan of articles, an early primary assumption (c. 1980-90) was that it was due to low body temperature, but more recent articles suggest it might be due to something else / multiple factors.
From this article: Lopez, M. B. (2018). Postanaesthetic shivering–from pathophysiology to prevention. Romanian journal of anaesthesia and intensive care, 25(1), 73. Full text:
"Shivering is usually triggered by hypothermia. However, it occurs even in normothermic patients during the perioperative period. The aetiology of shivering has been understood insufficiently. Another potential mechanism is pain and acute opioid withdrawal (especially with the use of short-acting narcotics)."
Thanks in advance for any comments.
In spite of the metaanalysis (Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares). Published in the
Chest. 2008 Jul;134(1):172-8.
Marik PE, Baram M, Vahid B, with the Conclusion:
(This systematic review demonstrated a very poor relationship between CVP and blood volume as well as the inability of CVP/DeltaCVP to predict the hemodynamic response to a fluid challenge. CVP should not be used to make clinical decisions regarding fluid management.) CVP may still the most widely used monitor for fluid management worldwide, do think that is true? Do you think it is accepted practice? And why?
Standard precautions are meant to reduce the risk of transmission of bloodborne and other pathogens from both recognized and unrecognized sources. (WHO) It is also recommended to assume that every person is potentially infected or colonized with an organism that could be transmitted in the health-care setting and apply the following infection control practices during the delivery of health care. (Guideline recommendation). Personal Protective equipment are to be used as one such measure. But I am unable to find whether the OT table and floor should also be covered with plastic? Please give your opinion with logic (reasoning) and evidences.
i need 15 minutes of the animal in anesthetic condition prescribed dose of ketamine is -80 mg/kg and for xylazine 10 mg/kg, why we can not use either ketamine or xylazine, plz let me know ?
I am looking for software (free or paid) that allows monitoring data to be extracted from the GE Carescape B850 anesthetic monitor. Ideally the data should be downloadable in a CSV or Excel file.
Few patients with cardiac disease undergoing cardiac surgery(CABG, valve replacement...etc) develop atrial fibrillation with rapid ventricular response after induction.Some anaesthetists treat this arrhythmia others prefer not to ;especially if it is on pump surgery,any studies!
In respiratory research a breathing apparatus consisting of mouthpiece, filter, Pneumotachometer, and non-rebreathing valves plus some connectors are usually used. Although a non-rebreathing valve is used to reduce dead space, each of these devices has its own dead space. Though small, adding together they build a relatively large dead space sometimes. What is the max acceptable dead space in a breathing apparatus, for a study including healthy adults?
I used to think that as Pcrit is the same during sedation and natural sleep, this means that the properties of the UA muscles remain intact under sedation, but then I read an old article that explained that because of the methodology to get the Pcrit, where the CPAP is on, the muscles don't have activity, and so you shouldn't expect to have a different Pcrit as, even if the drug would cause muscle relaxation, it would not make a difference in an already relaxed muscle....(Morrison DL, Launois SH, Isono S, Feroah TR, Whitelaw WA, Remmers JE. Pharyngeal narrowing and closing pressures in patients with obstructive sleep apnea.pdf. Am Rev Respir Dis. 1993;148:606–11.)
Now I'm reading an article by Eastwood about increasing dose of propofol and Pcrit and says that it increased Pcrit, so now I don't know what to think (Eastwood PR, Platt PR, Shepherd K, Maddison K, Hillman DR. Collapsibility of the upper airway at different concentrations of propofol anesthesia. Anesthesiology 2005;103(3):470–7.)
Can anyone explain me where's the problem?
Intraoperative awareness may lead to catastrophic psychologic sequelae (1), a fact motibating anesthesiologists to use neuromonitoring in oder to prevent awareness during operation. In the "B-Aware" trial, awareness associated with a BIS-guided protocol in patients at high risk of awareness occurred substantially less frequently than did awareness events in the control group (2). However, neuromonitoring on the basis of the bispectral index (BIS)-monitoring is mostly used for anesthesia induced by propofol and evidence for the safe prevention of awareness in patients monitored with BIS during narcosis induced by volatile anesthetics is limited.
1. Lennmarken C, Sydsjo G: Psychological consequences of awareness and their treatment. Best Pract Res Clin Anaesthesiol 2007; 21:357– 67
2. Myles PS, Leslie K, McNeil J, Forbes A, Chan MT: Bispectral index monitoring to prevent awareness during anaesthesia: The B-Aware randomised controlled trial. Lancet 2004; 363: 1757– 63
We're inducing repeated traumatic brain injuries in a closed-skull mouse model.
We chose isoflurane as the anesthetic because it doesn't have the neuro effects that injectables such as ketamine/xylazine do, and because it allows for quick recovery in order to be able to observe signs of TBI immediately.
It appears that after being anesthetized and impacted once (great recovery the first time), the mouse died during prep for the second impact. Isoflurane dosage was roughly the same as the first, successful impact, but the mouse died ~2-3 min after removal from gas chamber, at which point it was slightly under-anesthetized.
Is there a way to reduce the anesthesia dose while keeping the animal unconscious for the procedure? What differences in response to isoflurane would you expect in C57BL/6 mice? (the mouse above was BALB/c), and how would the mouse's age affect that prediction?
My goal is to record EEG during anesthesia and analyse the row signal of EEG. So I am not considering devices using ready-made algorithms like BIS or others. 4-channel EEG will be enough, the main point is to obtain row signal! If there is no way to plug such a device an our monitor, we will probably go for a full classic EEG.
In our hospital, we usually prepare endotracheal tube as immersing it into the sterile normal saline irrigation solution just before intubation in operation theatre.
I think that this maneuver helps to lubricate the endotracheal tube cuff to facilitate passage into the vocal cord and minimize dryness of throat and laryngeal injury.
I'm wondered whether this method is also used in other countries
How do you think about this? Please add your opinion or your routine maneuver.
I wanted to get some information on the anesthetic management for an
adenotonsillectomy in a child suffering from PFAPA.
What attentions have in conducting / medication management?
You possibly references that I can point to?
Thank you in advance for your attention, friendliness
Dear Dr. Piccini and colleagues,
Many thanks for sending e a full text version of Paraesthesia after Local Anaesthetics: An Analysis of Reports to the FDA Adverse Event Reporting System. It is a very important work.
You may be interested in my continued research subsequent to my 2006 paper that you kindly referred in your article.
If you send me your e mail address, I would be more than happy to send you my recent works, a combined clinical- and registry study, and an animal experiment.
Søren Hillerup, PhD, Dr Odont.
Professor em., Maxillofacial Surgery
Vitamin c 7 E has been implicated for analgesia.
Some recent advantages of pain relief with curcumin in mice have been reported.
Extracorporeal shock wave lithotripsy accompanies with pain. Is it worthwhile to perform intercostal nerve block for pain relief during ESWL?
What's the most useful tool you rely upon to prevent yourself from making an error, ensuring that you've entertained all the important possibilities? Do you have a favorite saying or memory aid that you teach trainees? This could be for a specific condition (like the Hs and Ts of PEA) or a general approach to ensure you aren't missing something.
I see many anesthesia techniques can be used for kidney transplantation.
In my hospital for recipient we use lower combined epidural & intravenous anesthesia (TCI propofol). Postoperative analgesia achieved by continous ropivacaine 0.15% + fentanyl 2 mcg/mL, rate 8 mL/hr via epidural catheter for 3 days and iv paracetamol.
For laparoscopic living donor we use combined epidural & general anesthesia (volatile). Postoperative analgesia: intermittent epidural bolus (bupivacaine 0.125%, morphine 2 mg, volume 10 mL, 2x/day) + iv paracetamol.
A Flow Trac gives a lot of information in managing a sick patient during surgery. What are your experiences? What group of patients do you usually use cardiac output monitoring on?
8 kg, 10 month old baby with a type I Chiari malformation.
This is a new procedure for our anesthesia department to be managing and I am looking for any advice/direction that would be helpful. Thank you.
Suggestions for links to articles?
Dexmedetomidine is used as an adjuvant to intrathecal local anesthetic (Bupivacaine/ Ropivacaine ). Does it help in prolonging duration of spinal anesthesia? How would you rate it on comparison to fentanyl/ morphine?
Hey , how are you doing today,
I did splenic injection of tumor cells with C57BL6 to accomplish liver metastasis.
,but I don't understand some results of my experiment,,
The main thing is that..
All mice woke up 1~2 hours after surgery, and they all looked fine.
However, 5 mice (among 48 mice) got weaker, and died 24~48 hours later.
I have checked bleeding, but no sign of bleeding was found.
Infection?, If it is about infection, is anti-biotic gonna be helpful?
Please give me some possible reasons for these deaths
1. Anethesia by using Ketamine/xylazine mixure (9:1).
2. the spleen was exteriorized via 5mm abdominal incision, and cell line was injected.
3. after 1 min (to allow cells to flow into the liver), splenectomy was done, and homoeostasis was assured by ligation with suture and pressure with a swab
Thank you for your time and concern, :)
We have been using Ketamine + Xylazine as a standard anaesthetic for mice in our lab. However, due to some policy problems, ketamine is no longer produced here in China. I wonder if there is any other anaesthetic that have similar anaesthetic effect on mice? Please help me. Thanks a million!
Recently we had a patient candidate for CABG who was alert and oriented. The first K after induction was 8 mEq/L. This number was confirmed by recheck. Two measurements on CPB were 6.5 (with low potassium cardiopledgia) and 7 (at the end of CPB). off pump K was 6.5 after giving insulin for BS=190 and NaHCO3 for acidosis (BE= -10). First postoperative K was 6.5 too. There was no EKG sign in perioperative period.
The patient had no Hx of renal problem with Cr=0.95 mg/dl. preop drug Hx included Aldacton 25 mg BD. however, last preop K was 4.8.
What's your opinion about this case?
In the analysis of research into the use of Citrate in the dialysis of ICU patients, there seems to be a positive swing towards the use of Citrate over other anticoagulants. With so many different types of modality being used with Citrate, Which mode seems to have the least complications? All suggestions welcome.
With the shortage of funds within the health service, can we really turn to SLED or SLEDD as an alternative to continuous renal replacement therapies?
It is often seen that patient complaints of chest pain, either in left side or in epigastrium, during cesarean section under spinal anesthesia. It specially seen during peritoneum stretching, uterus manipulation or rough handling of omentum etc. What is the probable cause and what should be the ideal prophylactic and therapeutic strategy?
Position plays a vital role in subarachnoid blockade specially while using hyperbaric local anesthetic agents. Sitting or supine position may affect the final height of the block. Is there any modification of positioning while using isobaric local anesthetic agents?
We use controlled breathing with LMA quite often. Some of my patients complain of stomachache following the surgery. Although appropriate sealing is achieved, it occurs to me that it could be due to air insufflation through LMA. What do you think? Any similar experiences?
This is quite bold but I am currently looking for a job. Since my degree will be in medicine I would very much like to get into patient care. Nevertheless I'm very fond of research and particularly psyched by systems biology, quantitative biology and emergent behavior in dynamic open systems since I did my pre-clinical studies.
My current problem is that I'm not quite sure where to turn to if I would like to pursue my scientific interests. I'm not bound to any specific discipline, but anesthesiology, internal medicine and neurology are my favorites at the moment.
Are there any hospitals participating in systems biology research in Europe? I was looking into it and found that Charité Berlin is the only hospital displaying their involvement.
I would be really grateful for some advice!
I've just started recording evoked potentials in mouse neocortical brain slices, using a constant voltage stimulus (0.1Hz at approx 1V). I see that most people use constant current generators for this purpose. Is a constant current stimulus essential to ensure stable responses over 1-2 hours?
I was attempting to anesthetize the animal with diazepam and ketamine, the pup vocalized throughout the surgical procedure (removal of dermoid).
I work at two centers with different approaches. Thank you for your response.
We use tried and tested methods in evaluating a trainee's academic progress but what of progress in terms of apprenticeship for the profession? I suspect most of us use a subjective/semi objective method of assessment based upon observation of the trainee's practical abilities in the OR, but to what extent is that progress identifiably due to interaction with a senior during supervised sessions, or due to the individual effort of the trainee? I suspect that it's a bit of both and that the balance alters during training, but is there any way of identifying each component? Can we identify the point at which a trainee is capable of the (often subconscious) complex situational analysis required of a specialist anaesthesiologist? Also, is there ever a point in a trainee's progress at which the presence of a senior in theatre becomes a hindrance rather than a help to further progress?
After CSE for labor, cesarean section performed in epidural and post operative analgesia without any problem, after catheter's removal we assisted to important spillage of cerebrospinal fluid for a lot of hours.
What is your practice, recommendations, and experience in optimizing preoperative Hb? When do you give Iron and Erythropoietin? Which one is superior? Any other alternatives to minimize perioperative blood transfusion?
I am performing in vivo electrophysiology on Sprague-Dawley rats, recording local field potentials and spiking activity in the VTA, SN and PFC.
I have narrowed my choices down to Chloral hydrate, Isoflurane and Urethane. Aside from differences in route of administration, are there any real advantages of one over the other? Is there a better anesthetic agent apart from these three I mentioned?
Hypothesis: Anesthesiologists are experts in resuscitation and crisis management, and if present at the scene of illness or injury and transport of selected critical patients, this will improve survival and reduce long term disability.
The use of levosimendan is discussed in some interesting papers published recently. Unfortunately, data on pediatric and neonatal populations remain weak. Moreover, even if pharmacokinetic studies exist, the exact dose scheme and timing for administration were not clearly established in this population. Do you administer a loading dose? Do you consider the administration of levosimendan at the end of cardiopulmonary bypass, just before surgery, the night before ? Does levosimendan decrease the total amount of vasoactive agents administered? Does levosimendan improve outcomes, ICU length of stay, morbidity, and mortality? I think that it would be interesting to start levosimendan infusion at least 12 hours before surgery. Would be interested to receive informations about your experience.