The old forum is resurrected and updated. We are back for all things anaesthesia.

You will go unconscious, perhaps fall to the ground and get a head injury your blood pressure will drop to dangerous levels, and your breathing may become obstructed. You could die. Don't do it.

Sure.

We would appreciate a link back to us

Cheers
Rob

Fixed.

Cheers
Rob

I get very smooth extubation conditions with my technique. Not 100% smooth, but either no coughing or attenuated coughing.

I do 2 things differently to you.

1. Do not paralyse. I use 1mg/kg lignocaine spray directly onto cords and below just after induction (sevo or propofol), then wait 30 seconds and intubate. Almost all children can be intubated easily without relaxant as long as you give the lignocaine enough time to work, and you have used an adequate induction. I use much higher doses of propofol 5-7mg/kg to acheive this. Hypotension in children is rarely an issue.

2. Get child to breath spontaneously during case (no relaxant used) and give enough narcotic (I use morphine upto 0.2mg/kg for simple tonsils and 0.1mg/kg for sleep apnea children) to get respiration rate down to the low teens before emergence.

The combination of lignocaine on cords and generous narcotic doses means a later waking time (my registrar often takes the patient out to recovery still intubated while I get started on the next case) but a much smoother waking.

Not sure

There is an anti-emetic (anti-nausea) medication called dexamethasone, often given routinely, that is described to cause groin pain if given too quickly. Not sure about rectal pain.

Why, oh why, oh why?

You seem to have listed all the disadvantages yourself, with no advantages.

Why not just do a simple, safe, well-established technique called general anaesthesia????

Quote from: ourdream on June 22, 2007, 12:28:23 AM
Which type of MD to see if this could be from the succinylcholine combined with the anesthesia.

The current muscle weakness is very UNLIKELY to be related to exposure to sux. She needs to see a neurologist for these new symptoms.

The prolonged weakness from sux is almost certainly sux apnea (more properly known as pseudocholinesterase deficiency). There is no treatment for it, and does not have any symptoms until patient is given sux. All she needs to do as far as this is concerned is tell all future anaesthetists about it.

This sounds like a case of "sux apnea". Succinylcholine is a muscle relaxant used most commonly for non-elective surgery. In the vast majority of people, the "sux" is metabolised within minutes and is then inactivated.

A very small percentage of people (about 1 in 2500) lack the enzyme to metabolise it and therefore the sux continues to work for many hours afterwards. During that time, it is best to keep the patient asleep to prevent the distress of feeling paralysed. Obviously, the patient needs to be artificially ventilated during that period. Once the sux is metabolised using other enzymes (after several hours), the anaesthetic can be turned off, the patient awakes and no harm done.

Sux apnea is not dangerous as long as it is recongnised. She will need to notify her anaesthtist about this condition for all future anaesthetics, and it would be advisable to wear a "medicalert" bracelet so that the condition is known even if she is not able to tell people (such as after an accident).

As sux apnea is a genetic condition, it would also be advisable to test direct family members - the patient's father and mother may also have the same condition, but it is more likely that they are "carriers" without actually being affected.

Now, sux apnea does not cause long-term effects, so the muscle spasms, and other symptoms would not be related to the exposure to sux. It is possible she has something quite different, such as a muscular dystrophy - more common in boys. Even then, the sux would not cause the long-term effects.

A muscle biopsy would be the test to do.

In Australia, all anaesthetics are given by doctors, the vast majority specialist-trained anaesthetists (in some country areas, there are still a few General Practitioners with a Diploma in Anaesthesia giving anaesthetics).

There are no nurse anaesthetists, or techs.

The Government is trying to institute nurse anaesthetists and our college is strongly opposed. Of course we are defending our territory, but also the extremely high safety record (Australia has the safest published anaesthesia record in the world).

Its all about money - it would certainly cheaper for the Govt to bring in nurse anaesthetists, but at what cost? Increased morbidity? Mortality? As is often stated by our college, "Would (insert politician's name) prefer to have their mother anaesthetised by a nurse or a medical specialist"?

This topic has been moved to General Discussion.

http://www.gasbag.net/index.php?topic=142.0

Interactive Clinical Pharmacology

http://www.icp.org.nz/index.htm

An excellent, interactive visual demonstration of pharmacokinetic and pharmacodynamic principles.

While its not strictly speaking a textbook for download, the Virtual Anaesthesia Textbook is a very large resource of online information.

Virtual Anaesthesia Machine at the University of Florida:

http://vam.anest.ufl.edu

Below is a set of links to really useful anaesthesia site.
Feel free to let me know about links you find useful, and I will include them.
cheers
Rob