Pimp Thread?

I will work on posting some more questions.

1. What byproduct is formed when using Sevoflurane?

a. What CO2 absorbents produce this byproduct the most to least?

b. Is it safe to run FGF

2. You have a mass casualty scenario and you have two patients that need to go back to the OR now (both patients are equally critical) but only one OR is available, but you have all the staff (surgeons, techs, etc., but only one anesthesia provider) and equipment you need for two operations: How do you handle this situation/Decide which patient goes or doesn't go?

3. For each degree C of temperature drop what percentage of CRMO2 change is expected?

1. compound A is formed when sevoflurane reacts with dessicated absorbant.

a. soda lime and barium hydroxide are the most likely to produce compound A, while calcium hydroxide (Amsorb) would be the least likely

b. Barash Clinical Anesthesia pg 423, M&M p 174; Renal and hepatic function in surgical patients after low-flow sevoflurane or isoflurane anesthesia ; Assessment of Low

2. good ethical question; I would attempt to apply the principles of triage here, after discussing with the surgeons which ever patient had the higher chance of survival after the surgery is the one I would select.

3. 5-7% decrease in CMRO2

1. Barium > Soda lime >>> Amsorb (which I don't think produces compound A to any noticeable levels) and Barium, I believe, is not available in the US. So, according to your reference you are saying it is safe to run low flow sevo even with renal patients?..

2. How about this instead of choosing one pt over the other: Bring both patients to the OR place them head to head where you can watch both of them, place one on TIVA with an outside vent as needed or have someone sit there and bag/get the patient spontaneously ventilating ASAP and do both cases at one time.

I had an anesthesia provider do a slide show presentation where they had went on a humanitarian mission. They were doing lots of peds cases, but OR space and time limits were extremely short. They actually set two kids on one stretcher (heads at opposite ends) and had two full surgical teams working at one time in the one OR. These aren't ideal situations, but they do happen. We discuss these type of scenarios in our military anesthesia training quite a bit.

3. I was taught 9% for every degree C, but I found 7% in this article. Clinical applications of induced hypothermia

OK I'm stumped! I know from being in the OR that EVERYONE runs sevo at least 2L/min FGF. BUT I remember learning that calcium hydroxide does not produce compound A. That is easy to find in some older (1998-2002) literature and my textbooks. However, I remember hearing in lecture that there was some other reason to administer sevo with 2L/min FGF, but I cannot find it in any of my textbooks, nothing after a quick lit search, and I can't find it in my notes.

I know old habits die hard, but if it does not produce compound A with Amsorb, and there is not some other reason to maintain 2L/min, I don't understand why everyone still would. It would save so much money to standardize running low fresh gas flows...so I imagine there must be a reason why we don't do it. Anyone want to help me out here?

Look at the write up in Barash about compound A. That should give you the answers you are looking for.

Math Problem: You are called at MN, because a patient's epidural on the floor has run out and the floor nurses cannot get hold of pharmacy to mix another bag. The patient's CLE is at running at 8ml/hr with a solution of 0.2% Ropivicaine w/ 2mcg per ml of Fentanyl. The supplies that you have on hand are 250ml bag of NS, 0.5% Ropivicaine, and 250mcg/5ml Fentanyl vials. How much Ropivicaine and Fentanyl do you need, and how would you mix it?

Name a medicine commonly given in the OR that acts as an MAOI?