February 2012
6 posts
1 tag
LMA Insertion Trick
Remove the plunger from a syringe attached to the LMA pilot balloon so it’s open to atmospheric pressure. The LMA cuff deforms as needed on insertion making it easier to place.
2 tags
Local Anaesthetic Dose
An easy way to remember the maximum dose of local anaesthetic in mililitres is: 1mL/kg of 0.25% bupivacaine/levobupivacaine/ropivacaine.
Surgeons often ask how much they can infiltrate safely and it’s easier to calculate this volume in your head, rather than calculate mg/kg and then convert to volume.
For example, a 15kg child could have up to 15mL of 0.25% bupivacaine, or 7.5mL 0.5%...
3 tags
Not Always Top 5 - Laryngospasm
100% O2
Laryngospasm notch pressure
CPAP or positive pressure ventilation
Lignocaine on the cords
Induction dose of propofol
Suxamethonium IV (1 to 2mg/kg) or IM (4mg/kg)
PS - Laryngeal notch pressure: Firm pressure to the notch behind the earlobe, bounded by the mastoid process, base of skull and condyle of mandible. Pressure on both sides in a cephalad and medial direction can terminate...
3 tags
Not Always Top 5 - Emergence Agitation
Occurs in about 10% of children
Lasts about 20 minutes
Characterised by crying, lack of eye contact, non purposeful actions/verbalisations
Exclude other causes (pain, hypoxia, hypercarbia, hypotension, raised ICP, full bladder)
Clonidine 1mcg/kg IV works well
PS - Getting parents in to calm a child with emergence agitation is not helpful, as the child is in a dissociated state and will not...
2 tags
WatchSimple device for spraying vocal cords. All you need is a bottle of local and a small needle. Make a hole in the bottle with the needle and aim the jet at the cords.
3 tags
Ultrasound for Vascular Access Tricks
Ultrasound for vascular access in paediatrics can be really useful. The problem is that the distance between the probe and your target might be so small that you can’t see the needle on the screen before it has gone through the target!
To increase this distance put a thick layer of gel on the probe and use a clear dressing to keep it in place. You can almost get an extra 1cm to play...
January 2012
6 posts
2 tags
Nasopharyngeal Murphy eye
Nasopharyngeal airways need a Murphy eye too. Cut your own before insertion. The hole should be opposite and proximal to the manufactured lumen.
PS - Use a 15mm endotracheal connector to connect your nasopharyngeal airway to an anaesthetic machine. This can be really useful for ENT laryngoscopy as the surgeon has an airway-device-free-view! Need spontaneously breathing patient and propofol...
2 tags
LMA with Gastric Lumen Tips
The whole idea of having a PLMA with an oesophageal tube (eg: ProSeal), is to protect the glottis from regurgitation. Any gastric contents refluxing up the oesaphagus SHOULD come out the oesophageal tube. Therefore the oesophageal lumen needs to be lined up with the oesopahgus. This is not always the case when inserting the PLMA blindly. So, to ensure correct placement :
Lubricate bougie...
3 tags
Not Always Top 5 Long QT
Talk to the patient’s cardiologist - beta blocked?
Normal electrolytes
Check defibrillator (internal and/or external)
Avoid tachycardia and bradycardia
Avoid ondansetron and reversal (if possible). Use propofol (maybe)
Know magnesium dose for treatment of torsades: 30mg/kg MgSO4 over 3 minutes IV
PS - 50% MgSO4 = 500mg/mL = 2mmol/mL = 4mEq/mL
2 tags
TEG Made Easy
Prolonged R time (slow clotting speed) needs FFP
Narrowed Maximum Amplitude (weak clot strength) needs platelets
Low A30/60 (low clot stability) needs TXA
3 tags
2 tags
December 2011
3 posts
3 tags
Estimating Weight In Children
An easy way to estimate the weight of a child without a formula:
- Term baby 3kg
- 1 year old 10kg
- 5 year old 20kg
Formulae can be hard to remember, especially in paediatrics where most of the terms of the various formulae are similar: Is it age/4+4, or 2(age+4), or 12 + (age/2)? The weight formula 2(age+4)kg is also becoming less accurate as the population becomes heavier and heavier.
3 tags
Not Always Top 5 - Duchenne's
Cardiac and respiratory function
No suxamethonium or volatile (anaesthesia induced rhabdomyolysis)
Reflux
Obese
Bleeding risk
PS - An easy way to think about the problems of Duchenne’s is to remember that all muscle types are affected: striated muscle, cardiac muscle and smooth muscle.
2 tags
Not Always Top 5 - Explained
The Not Alway Top 5 posts are aimed at registrars sitting the ANZCA final exam. They list a few important points by topic. Sometimes they’re 5 points, sometimes more, sometimes less. They are definitely not all inclusive! I found them useful to remember when I was preparing for the final SAQs and the viva. I thought that if I could remember three or more specific points about a topic then I...
November 2011
1 post
3 tags
