For those knowledgable about the use of ketorolac (IV NSAID), what is the maximum IV dose.  Some of my colleagues give 60 mg IV, but I have been unable to find any literature supporting more than 30 mg IV (although 60 mg may be given IM).

Has anyone ever seen an allergic reaction to NMBD's (esp. rocuronium).  According to texts these are the most allergenic drugs anesthesiologists use on a regular basis, so I would assume that eventually one would see it (I have not).  If you have what are the most common manifestations, is there any routine preventive measure possible, and is it possible to distinguish from the other induction agents/abx given at the beginning of surgery?

Many nurses seem to believe that a minimum PIV size of 20g is required for blood transfusion and in fact I was told this as well during training.

However, after a brief internet search I can not find any evidence to support this and further it does not appeal to common sense (a 7 micron RBC should fit through even the smallest PIV)

Comments?

I recently had a nearly very bad situation when I repeated 1/2 a dose of succinylcholine (about 5 min after the original dose) to a healthy 23 y/o male.  Unknown to me, on further reading, I found this to be a well recognized complication of succinylcholine; especially because I have done this often in the past when managing difficult airways.

Does anyone else have similar experiences?

Does anyone have any experience using succinylcholine for very short term muscle relaxation when requested by the surgeon?

On researching less demanding postop analgesia techniques, I came across the 5% lidocaine patch which I was familiar with from my pain management fellowship.  I could only find a few studies and only access one of those regarding its use.  The one I did access showed no decrease in postop morphine use but showed decrease in pain scores with coughing (when used after radical retropubic prostatectomy).  Many of the links referenced its use in cats and dogs.  Does anyone have any personal experience with its use for postop analgesia or know of any additional studies?

I have recently become interested in these as my group have decreased the number of epidurals we leave in because of anticoagulation, reimbursement, and followup issues.

I have done a handful with and without ultrasound guidance, with varying effectiveness.

Anybody have more experience with these?  Could you share some helpful pointers?

Most of the sources say that the goal is to inject between IO and TA, although some say that the nerves can penetrate IO laterally and lie between EO and IO.

I do not have access to blunt needles so the so-called "double pop" technique is not much of an option; instead when performing the block blind I use a 25 g 1.5 inch needle which I doubt reaches the TA plane in my obese patient population (TX, USA).

Any thoughts?

I have used the proseal LMA (one with gastric drain) for CEA in the past.  I found it allowed a quicker wake up than with ETT, hence earlier evaluation for neurologic deficits.  I stopped after some negative feedback from a surgeon and the rest of my group (I am significantly junior), but I still think it to be a useful technique.

Anyone with similar experience?