Anesthesiology and Intensive Care

MANAGEMENT OF HIGH SPINAL BLOCK  1. Recognition of high spinal and call for help  2. If only circulatory compromise: Correction of bradycardia and hypotension.  Lateral displacement of uterus manually, with a wedge under the patient or by tilting the theatre table. Vagolytics like Atropine 0.6mg can be useful for severe bradycardia.  For hypotension, Phenylephrine13 boluses of 50-100mcg can be given. It can also be given as an infusion 20-40ml/hr (in a concentration of 100mcg/ml or as per hospital protocol). Ephedrine in 6mg boluses can also be given if there is hypotension and bradycardia.  Metaraminol boluses of 0.5mg or as an infusion in a concentration of 0.5mg/ml.  Mephentermine14 has been used as a 3-5mg intravenous bolus or intravenous infusion of 2-5mg/min, or 25-50mg intramuscularly. Limited information is available regarding placental transfer and foetal metabolic effects, although it is a popular agent in a number of low and middle-income countries. IV fluids -

A high neuraxial block is a sensorimotor block that has reached a spinal segmental level higher than that required to achieve surgical anaesthesia. The terms high, total or complete block are used interchangeably. A sensory level of T3 or above can be associated with significant cardiovascular and respiratory compromise and can hence be considered a high block. Involvement of the cranial nerves signifies intracranial spread of local anaesthetic which can culminate in complete loss of consciousness and cardiorespiratory arrest.

The following are key points to remember from the 2019 European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) guidelines for the management of dyslipidemias: lipid modification to reduce cardiovascular (CV) risk:

O bstetric patients are at increased risk of failed intubation due to a number of unique clinical, environmental and human factors. Despite widely publicised ‘failed intubation drills’ and advances in airway equipment and techniques, the incidence of failed obstetric tracheal intubation has not changed for more than 40 years, and remains higher than in the non-obstetric population. A recent literature review found an incidence of failed tracheal intubation of 2.6 per 1000 obstetric general anaesthetics (1 in 390) and associated maternal mortality of 2.3 per 100 000 general anaesthetics (one death for every ninety failed intubations). Given the difficulties in accurately predicting difficult intubation, and the unchanged rate of failed obstetric tracheal intubation, there has been a shift in focus away from efforts to primarily reduce rates of failed intubation towards a greater appreciation of measures to maintain oxygenation and to control associated human factors that may i

Sedation is a continuum which extends from a normal conscious level to being fully unresponsive.    Indications for procedural sedation, stratified by urgency Emergent (e.g. cardioversion for life-threatening dysrhythmia, reduction of markedly angulated fracture/dislocation with soft tissue or vascular compromise, intractable pain or suffering). Urgent (e.g. care of dirty wounds and lacerations, animal and human bites, fracture reduction, shoulder reduction, hip reduction, arthrocentesis, neuroimaging for trauma). Semi-urgent (e.g. care of clean wounds and lacerations, foreign body removal, sexual assault examination). The pharmacological agents typically used for procedural sedation

Author:  Victoria L Henson /  Editor:  Jason M Kendall /  Reviewer:  Louise Burrows /  Code:   CAP6, CAP7, HAP8  /  Published:  09/11/2017  Review Date:  09/11/2020 The priorities are to relieve symptoms and to restore haemodynamic stability and tissue perfusion. The approach to management is summarised in Box 5. Box 5: Emergency Management of CPO: Airway Positioning Breathing High flow O2 CPAP/BiPAP Circulation Nitrates Furosemide Disability Morphine Exposure Positioning (a) Airway Allow the patient to find the best position for their airway and breathing. If the airway is compromised intervene as required. This may be due to (i) a reduction in conscious level due to hypoxia, hypercapnoea or excessive opiate administration, or (ii) due to pulmonary oedema fluid exuding from the lungs. (b) Breathing (i) Oxygen High flow O2: 15L/minute with a reservoir bag is required for most patients (unless known to retain CO2), as hypoxia is frequently the

Taking into account historical criteria and additional consultations with European and North American surgeons with experience from clinical trials and event adjudication the Subcommittee on Control of Anticoagulation has approved the following recommendation for definition of major bleeding in surgical studies.

Selection of Catheter Insertion Site.