http://scienceblogs.com/neurophilosophy/

Not really enough information on this one. How long was the CPR, How was the
blood gas obtained-art/venous, do you have a formal ECG trace or Rythm strip
from the episode? No Art line involved? Where was the blood gas obtained and how
hard had the patient been ventilated (intubated?)�and what was the CO2 in the
ABG? Was there a rapid infusion of saline in that limb diluting the K+? Was the
reversal really something else? Anaphylaxis? Was it V tach or abberant
conduction of SVT? How do we know? What does "all investigations normal" really
mean? What was the outcome and what follow up cardiac procedures were
instituted? How long was CPR and how long was BP not measured or obtained.

Thanks
P Kempen

"Inquiring minds want to know................."
��� ��� ����� ��� � National Inquirer


Posted by: "rjoglekar57" rjoglekar57@...�� rjoglekar57
Mon Nov 16, 2009 7:26 am (PST)

A 40 year old male operated for a nodule on vocal cord. ASA grade 1. All
investigations within normal limits.(pre op electrolytes not done) Patient went
into ventrcular tacycardia 4 minuts after reversal with glycopyrolate &
neostigmine, just before extubation. repeated dc shocks , corderone, CPR
required to get sinus sythm. subsequent investigations revealed K+ of 2.2 mEq/L
as most likely cause. ( post resuscitation ECG, 2D Echocardiography within
normal limits, angiography awaited)
Question is why a patient in absence of renal/ GI disturbance or medications
developed hypokalemia? Any suggestions?

 

Anesth Analg 2009; 109:1805-1808 © 2009 International Anesthesia Research Society doi: 10.1213/ANE.0b013e3181be371b AMBULATORY ANESTHESIOLOGY Systemic Lidocaine Decreased the Perioperative Opioid Analgesic Requirements but Failed to Reduce Discharge Time After Ambulatory Surgery Allannah McKay, MD*, Antje Gottschalk, MD*<image001.gif>, Annette Ploppa, MD*<image002.gif>, Marcel E. Durieux, MD, PhD*, and Danja S. Groves, MD, PhD* From the *Department of Anesthesia, University of Virginia, Charlottesville, Virginia; <image001.gif>Department of Anesthesiology and Intensive Care Medicine, University of Muenster, Muenster; and <image002.gif>Department of Anesthesiology and Intensive Care Medicine, Eberhard-Karls University, Tuebingen, Germany. Address correspondence to Danja S. Groves, MD, PhD, Department of Anesthesia, University of Virginia, PO Box 800710, Charlottesville, VA 22908-0710. Address e-mail to dgroves@virginia.edu. Abstract BACKGROUND: In this randomized, blinded, placebo-controlled trial, we evaluated whether systemic lidocaine would reduce pain and time to discharge in ambulatory surgery patients. METHODS: Sixty-seven patients were enrolled to receive lidocaine or saline infusion perioperatively. RESULTS: Length of postanesthesia care unit (PACU) stay did not differ between groups. Intraoperative opioid use was significantly less in the lidocaine group, both in the PACU and during the total study period but not after discharge. In the PACU, patients in the lidocaine group reported less pain (visual analog scale score 3.1 ± 2.04 vs 4.5 ± 2.9; P = 0.043). There were no differences in postoperative nausea and vomiting. CONCLUSION: Perioperative systemic lidocaine significantly reduces opioid requirements in the ambulatory setting without affecting time to discharge.

 

 

Dear Ron   you mentioned that 350 children died this past month in USA , i agree with you , but ,   do you know how many children died from  virus A ?  ( usual influza ) ?   the problem with the vaccination for H1N1 , that the US government agreed that the companies are devoided from any responsibility concerning side effect ! do you find this   logical ?  , that the company will not take responsibility of any future possible complications ( e.g. guillan Barre' , MS ,... )     Regards ,   A.zeidan --- On Tue, 11/17/09, ethersage <ethersage@yahoo.com> wrote: From: ethersage <ethersage@yahoo.com> Subject: Re: [ai] Vaccination or not? To: Anesthideas@yahoogroups.com Date: Tuesday, November 17, 2009, 11:13 PM   350 children died this past month in the US from influenza   Ron Shenker From: ahed m.zeidan <doczeidan@yahoo. com> To: Anesthideas@ yahoogroups. com Sent: Tue, November 17, 2009 12:30:27 PM Subject: Re: [ai] Vaccination or not?   I dont believe it is necessary, H1N1 is not dangerous as they like to say that .   i saw many patients recovered within few days ,   however, a freind of mine , after vaccination, complained from high grade fever for 48h + plus sensation of legs paralysis and severe general weakness for 7 days , others freinds toke it withou feelinfganything !     Ahed zeidan , M.D --- On Tue, 11/17/09, JJ <achaeusz@hotmail. com> wrote: From: JJ <achaeusz@hotmail. com> Subject: [ai] Vaccination or not? To: Anesthideas@ yahoogroups. com Date: Tuesday, November 17, 2009, 6:55 PM   Hello everyone. This week massive vaccination against H1N1 has begun in my country. Have you yet had your shot? Will you? Thank you for your response Ioannis Zogogiannis

Vic: I think the vasopressors **are** being administered to fight hypotension,
and not just for the "fun of it". As for the metabolic rate, the other� and most
important question is of "statistical vs clinical" relevance. A little metabolic
rate keeps us all alive and warm when coming out to the "pool".

P Kempen



Re: phenylephrine drips and BP
Posted by: "Vic Werlhof" werlhof@...�� vicwerlhof
Fri Nov 13, 2009 2:17 pm (PST)

As for the phenylephrine and vascular perfusion, I will state there is
simply a great deal of "voodoo medicine" and associated beliefs out there.
Take a look at the OB literature which is NOW proclaiming phenyleprine to be
superior to ephedrine! (personally, they both are only as good as they
create BP, some people resopnd to the one or other drug).<<<<<< <
If I am understanding the literature correctly, the support for
phenylephrine is not about BP control. During C-sections, ephedrine has
been shown to lower pH in the fetus by increasing metabolic rate. That is
why phenylephrine is being touted as superior.
Vic

Palliative Sedation to Alleviate Intractable Distress of the Dying
Patient
A review of treatment options



Patients who are dying can experience physical and emotional
suffering,
such as anxiety, agitated depression, or insomnia. Physicians often
administer nonopioid drugs to alleviate such symptoms (ordinary
sedation).
However, in some instances, suffering is severe and refractory to
conventional treatment, and further palliative sedation is medically
indicated. In a review of palliative sedation options, palliative
care
specialists distinguish treatment for refractory symptoms as either
proportionate palliative sedation (PPS) or palliative sedation to
unconsciousness (PSU).

With PPS, sedation at the lowest possible level is administered to
relieve
suffering, and increases in dosage are tied to persistent signs and
symptoms of distress. Unconsciousness is a foreseen but unintended
side
effect. Patients with refractory symptoms often respond to increasing
doses
of benzodiazepines, haloperidol, chlorpromazine, barbiturates, or
propofol.
Because opiates can lead to development of tolerance and
neurotoxicity,
their use should be restricted to patients in whom pain or dyspnea
cannot
be controlled with other medications.

With PSU, sedation is increased rapidly until the patient is no
longer
responsive. Unconsciousness is the intended goal, rather than a side
effect. PSU might be applicable for patients with refractory
symptoms,
such
as severe respiratory secretions or severe nausea, or for those with
predominantly existential suffering, such as anguish and fear, that
often
accompany the dying process.

Both types of sedation, although legal, raise ethical concerns and
are
challenged by those who fear that such practices hasten death.
However,
unlike physician-assisted suicide or euthanasia, the intent of PPS
and PSU
is to relieve refractory suffering in patients who are dying. Death
is
secondary to the underlying disease process, and data show that
palliative
sedation does not shorten survival. In addition, we must distinguish
related questions about provision of or withholding nutrition and
hydration
as separate and distinct from administration of PPS and PSU: Many
patients
and their surrogates make informed decisions to discontinue
nutritional
support when it is not within their goals of care or because of
unacceptable side effects, such as nausea or excessive respiratory
secretions. Nevertheless, withholding nutrition and hydration is not
a
requirement for effective palliative sedation.

National policies and guidelines support both conscious and
unconscious
palliative sedation. Either one can be offered to terminal patients
who
are
experiencing refractory suffering, with safeguards and internal
institutional review to guide the practice. Safeguards include peer
consultation to confirm that a patient is near death and is
experiencing
refractory symptoms. Institutional policies and procedures can help
standardize practice, remove moral ambiguity that is related to
sedation,
and, ultimately, improve the quality of symptom management for
terminally
ill patients.

-- Stephanie Grossman, MD, FHM, FAAPM

Dr. Grossman is an Assistant Professor in the School of Medicine at
Emory
University and Director of Palliative Care at Emory University
Hospital
and
Emory University Hospital Midtown in Atlanta, Georgia.

Published in Journal Watch Hospital Medicine November 16, 2009
Citation(s):

Quill TE et al. Last-resort options for palliative sedation. Ann
Intern Med 2009 Sep 15; 151:421. (Subscription may be required)
(Free)

  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.

Hello everyone.
This week massive vaccination against H1N1 has begun in my country. Have you yet
had your shot? Will you?

Thank you for your response
Ioannis Zogogiannis

 

Wow,

Thought this stuff was not supposed to happen??  Maybe herbal teas or meds and diuretics? 

On Mon, Nov 16, 2009 at 7:26 AM, rjoglekar57 <rjoglekar57@yahoo.co.in> wrote:

 

A 40 year old male operated for a nodule on vocal cord. ASA grade 1. All investigations within normal limits.(pre op electrolytes not done) Patient went into ventrcular tacycardia 4 minuts after reversal with glycopyrolate & neostigmine,just before extubation. repeated dc shocks , corderone, CPR required to get sinus sythm. subsequent investigations revealed K+ of 2.2 mEq/L as most likely cause. ( post resuscitation ECG, 2D Echocardiography within normal limits, angiography awaited)
Question is why a patient in absence of renal/ GI disturbance or medications developed hypokalemia? Any suggestions?

--
Terry Webber, MD, JD
Anesthesiology
12600 Braddock Drive, C-205
Los Angeles, CA  90066
Phone: 720 490 6824
Fax: 310 733 1770

 

A 40 year old male operated for a nodule on vocal cord. ASA grade 1. All investigations within normal limits.(pre op electrolytes not done) Patient went into ventrcular tacycardia 4 minuts after reversal with glycopyrolate & neostigmine,just before extubation. repeated dc shocks , corderone, CPR required to get sinus sythm. subsequent investigations revealed K+ of 2.2 mEq/L as most likely cause. ( post resuscitation ECG, 2D Echocardiography within normal limits, angiography awaited)
Question is why a patient in absence of renal/ GI disturbance or medications developed hypokalemia? Any suggestions?

A 40 year old male operated for a nodule on vocal cord. ASA grade 1. All
investigations within normal limits.(pre op electrolytes not done) Patient went
into ventrcular tacycardia 4 minuts after reversal with glycopyrolate &
neostigmine,just before extubation. repeated dc shocks , corderone, CPR required
to get sinus sythm. subsequent investigations revealed K+ of 2.2 mEq/L as most
likely cause. ( post resuscitation ECG, 2D Echocardiography within normal
limits, angiography awaited)
Question is why a patient in absence of renal/ GI disturbance or medications
developed hypokalemia? Any suggestions?

For those interested in trauma - videos from 2008  London Trauma Transfusion and Coagulopathy Symposium: http://www.trauma.org/index.php/main/article/713/   Any members utilize massive transfusion protocols ? What's yur experience with them ?   Ivan Hronek MD Los Angeles, CA http://health.groups.yahoo.com/group/Anesthideas/ Do not fear to be eccentric in opinion, for every opinion now accepted was once eccentric. Bertrand Russell   Confidentiality Notice: This transmission and any attached documents may be confidential and contain information protected by State and Federal Medical Privacy statutes and is legally privileged. They are intended for use only by the addressee. If you are not the intended recipient of this transmission, or an agent of the intended recipient, you are prohibited from reading, disclosing, printing, saving, copying, using, or otherwise disseminating any information contained in this transmission. If you received this transmission in error, please accept our apologies and notify me at ivanhronek@... and delete the entire message and its attachments. Thank you. Disclaimer: this message contains the personal views of the author. The author will not be responsible in any way for procedures or approaches performed in the way suggested in this note. <--static--liam_party_bottomright.jpg>