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1-1-8 one-step sevoflurane wash-in scheme for low-flow anesthesia: simple, rapid, and predictable induction
Published: 24 January 2020
Sirirat Tribuddharat, Thepakorn Sathitkarnmanee, Naruemon Vattanasiriporn, Maneerat Thananun, Duangthida Nonlhaopol & Wilawan Somdee BMC Anesthesiology volume 20, Article number: 23 (2020)
My Keypoints: Due to Sevoflurance’s high cost, Low-Flow Anesthesia (LFA; fresh gas flow (FGF) ≤ 1 L·min− 1) is used to reduce the amount needed, thus significantly lowering costs.
For example, one case that is one hour long could cost:
- FGF 6 L/min = $40/hour
- FGF 3 L/min (standard flow rate) = $20/hour
- FGF 1.5 L/min = $10/hour, then switch to Isoflurane = $2/hour
Previously, the recommended lowest FGF to be used with sevoflurane was 1 L·min− 1 for exposures up to 1 h and 2 L·min− 1 for exposures > 1 h because of compound A concern. With the introduction of strong base-free CO2 absorbents (e.g., Amsorb Plus and Litholyme), the issue with compound A from sevoflurane has been resolved and sevoflurane can be safely used in LFA.
In-Flight Medical Emergencies:
By Christian Martin-Gill, MD, MPH; Thomas J. Doyle, MD, MPH; Donald M. Yealy, MD January 7, 2019
Cabin pressurization leads to the expansion of closed gas-containing spaces in the body (eg, sinuses and middle ear) and nonphysiological gas collections (eg, pneumothorax or following gastrointestinal, ocular, or intracranial surgery). The aircraft cabin has a lower partial pressure of oxygen at altitude, with resultant mild hypoxia in healthy passengers (decreasing mean arterial oxygen saturation from 97% to 93%). This effect can be more pronounced or symptomatic in passengers with existing pulmonary conditions.
Infection Control in Anesthesiology
Situations Leading to Reduced Effectiveness of Current Hand Hygiene against Infectious Mucus from Influenza Virus-Infected Patients Simple handwashing — even without soap — is more effective than many hand disinfectants for killing Influenza A virus (IAV) in typical clinical situations, new data show. September 23, 2019 Medscape
New Guidance Outlines Recommendations for Infection Control in Anesthesiology. December 11, 2018
Safe Practices for Medical Injections– CDC.gov
- Proper hand hygiene should be performed before handling medications.
- The rubber septum of the medication bottle should be disinfected with alcohol prior to piercing it. The exterior of the glass vial should be disinfected.
- A needle should not be left inserted into a medication vial septum for multiple uses.
Medications
Propofol use in children with allergies to egg, peanut, soybean or other legumes: This study concluded that genuine serious allergic reaction to propofol is rare and is not reliably predicted by a history of food allergy.
Anesthesia Gases: Costs and Waste
Succinylcholine Chloride: PACU Storage Protocol
Discharge Readiness After Propofol With or Without Dexmedetomidine for Colonoscopy Leonard U. Edokpolo, et.al. Anesthesiology. 2019;131(2):279-286. FDA Dexmedetomidine Hydrochloride Injection is a central alpha-2 adrenergic.
Intralipid Treatment of Bupicavaine Toxicity
Pete Stiles, BA; Richard C. Prielipp MD, MBA, FCCM
A plausible dosing application to consider after “all standard resuscitation methods fail to re-establish sufficient circulatory stability” would be as follows:
20% Intralipid:
- Administer 1.5 mL/kg as an initial bolus; the bolus can be repeated 1- 2 times for persistent asystole.
- Start an infusion at 0.25 mL/kg/min for 30-60 minutes; increase infusion rate up to 0.50 mL/kg/min for refractory hypotension
Blog Comments:
- Propofol ~ 20 mL (200 mg) single-use vial
- Dexmedetomidine hydrochloride in 0.9% Sodium Chloride) injection 80 mcg/20 mL (4 mcg/mL) per multi-dose vial
- Dexmedetomidine hydrochloride ~ 2 mL (200 mcg)
Operating Room Anesthesia Cart
Pediatric and Adult Anesthesia Equipment
Procedure Room Anesthesia Cart
Pediatric and Adult Anesthesia Equipment for closed reduction fractures in the procedure rooms and gastroenterology endoscopies in the GI Procedure Room.
Emergency Equipment Storage
Emergency Crash Cart for Pediatric and Adult
Crash Cart Preparedness by the Joint Commission.
GlideScope® SpectrumTM Single-Use Video Laryngoscopes Pediatric & Adult
GlideScope® SpectrumTM Single-use video laryngoscopes combine fully disposable low profile blades cover a patient range from neonate to large adult.
Inservice Video GlideScope® SpectrumTM
Adult Intubation scope (Ambu® aScope™)
Adult Intubation scope (Ambu® aScope™) is a sterile single-use flexible adult Intubation scope. Ambu® aScope™ 4 Broncho Slim 3.8/1.2 and Ambu® aScope™ 4 Broncho Regular 5.0/2.2.
PACU Emergency Airway Cart
Pediatric and Adult Anesthesia Airway Equipment
Difficult Airway Cart
If location permits, the Difficult Airway Cart may double as a PACU Emergency Airway Cart with Pediatric and Adult Anesthesia Airway Equipment. The Pediatric Fiberoptic Intubation Endoscope is located in this cart.
- PACU Emergency Airway Cart Pediatric & Adult
- Difficult Airway Cart Pediatric & Adult
- Pediatric Fiberoptic Intubation Endoscope (3.5 ETT)
- Emergency Quick Trach Cricothyrotomy Pediatric and Adult
- Difficult Airway Equipment
Pediatric Fiberoptic Intubation Endoscope
Pediatric Fiberoptic Intubation Endoscope (Olympus LF-DP) for difficult intubation has a 3.1 outer diameter (OD) that will fit in a 3.5 ETT (3.5 mm ID with a ~ 4.8 mm OD. See the tracheal tube sizing chart below.
Malignant Hyperthermia Cart and Ryanodex®
Malignant Hyperthermia Cart and Ryanodex® dantrolene sodium new formulation. Ryanodex® is a new lyophilized formulation of dantrolene sodium that can be reconstituted and administered in less than 1 minute. Visit MHAUS.org managing an MH crisis.
- Malignant Hyperthermia (MHAUS) Hotline Call 1-800-644-9737
- Malignant Hyperthermia (MHAUS) Management
- Malignant Hyperthermia (MHAUS) Cart Contents
- Malignant Hyperthermia Machine Preparation in 90 seconds with Vapor-Clean (Video)
Tracheal Sizing Guide – ID and OD
Olympus LF-P intubation fiberscope (2.2 mm outer diameter) for infants less than 6 months with airways requiring a 3.0 to 3.5 mm ID (internal diameter) endotracheal tube or less. This would be required if we anesthetized children ~ less than 3-6 months (ear tubes, urology, cleft lips).
Infants 0–3 months with a smaller/narrowed airway diameter (< 3 kg): ETT 3 ID with a 4.2 OD Olympus LF-P intubation fiberscope (2.2 mm outer diameter)
Infants 0–3 months: ETT 3.5 ID with a 4.8 OD PortaView® LF-DP 3.1 mm diameter insertion tube
