mwbeah

You know that anesthesia gets blamed for everything..................

If I were you I would research the literature involving the effects of hysterectomy on memory (some sources quote 67% of women have memory deficits after this procedure). Mike

Either there is an echo in here or zrmorgan and mick are sitting right next to each other, this is exactly what he posted earlier...................

you are mistaken sir, i have use either air or saline with lor (depends on the syringe in the kit). 2-5 cc of air is benign. i have placed many, many, many epidurals with either air or saline lor technique. if it were so dangerous, i don't believe anesthesia and analgesia would have printed this article: the median effective dose of intrathecal hyperbaric bupivacaine is larger in the single-shot spinal as compared with the combined spinal-epidural technique raymond wee-lip goy, mmed anesthesia, fanzca, yoong chee-seng, mmed anesthesia, fams, alex tiong-heng sia, mmed anesthesia, koay choo-kok, mmed anesthesia, fanzca, fams, and shen liang, msc department of anesthesia and intensive care, changi general hospital, singapore address correspondence and reprint requests to raymond wee-lip goy, mmed anesthesia, fanzca, department of anesthesia, national university hospital, 5 lower kent ridge rd., singapore 119074. address e-mail to [email protected] . the combined spinal-epidural technique (cse) has been associated with prolonged motor recovery and more frequent arterial hypotension as compared with a single-shot spinal (sss) technique. we determined the median effective dose (med) of intrathecal hyperbaric bupivacaine for cse and sss by using the up-down sequential allocation technique. sixty male patients were randomly allocated to receive intrathecal administration through an sss or cse technique. needle insertion occurred at the l3-4 interspace in all patients. in sss, 9.5 mg of hyperbaric bupivacaine was administered through a 27-gauge whitacre spinal needle. in cse, a 17-gauge tuohy needle with 4 ml of air was used to locate the epidural space, through which a 27-gauge whitacre spinal needle was introduced and 7.0 mg of hyperbaric bupivacaine was administered. the dosing adjustment was 0.5 mg. a "successful" outcome was arbitrarily defined as sensory anesthesia at or above the t6 dermatome lasting for 60 min. a "success" resulted in a 0.5-mg decrement, whereas a "failure" resulted in a 0.5-mg increment in the next patient. there were 13 successes in both groups. the med of bupivacaine was 9.18 mg (95% confidence interval, 8.89-9.47 mg) for cse as compared with 11.37 mg (95% confidence interval, 10.88-11.86 mg) for sss (p mike

She had stated this would be after completion of her BSN. Mike

It depends on how long ago you took the course, but usually the answer seems to be yes. I do know of many people who had to retake it, but not everyone had to. Mike

"If there is a doubt, why pull it out?" Mike

I am in the Uniformed Services University PhD program in Neuroscience www.usuhs.mil Mike

hyperventilation aims at keeping the pco2 down to 30-25 mm hg so that cbf falls and cerebral blood volume is reduced and thereby reducing the icp. prolonged hyperventilation should be avoided and becomes in- effective after about 24 hrs. in addition it causes hypo tension due to decreased venous return . it is claimed a pco2 under 20 results in ischemia, although there is no experimental proof for the same. the present trend is to maintain normal ventilation with pco2 in the range of 30 - 35 mmhg and po2 of 120 - 140 mmhg. when there is clinical deterioration such as pupillary dilatation or widened pulse pressure, hyperventilation may be instituted (preferably with an ambu bag) until the icp comes down. http://www.thamburaj.com/intracranial_pressure.htm

you may also want to review this article, it states a couple of reasons why physotigmine might be useful. anaesthesiol reanim. 1989;14(4):235-41.[color=#336699]related articles, [color=#336699]links [physostigmine--recent pharmacologic data and their significance for practical use] [article in german] rupreht j, schneck hj, dworacek b. physostigmine is widely used for treatment of the central anticholinergic syndrome during recovery from anaesthesia. the drug is also very useful in treatment of intoxicated patients, in differential-diagnostic procedures of coma of unknown origin, and in restoration of vigilance after prolonged sedation for mechanical ventilation. besides the specific central cholinergic action of physostigmine, several new pharmacological actions have now been established. analgesic action is dependent on the interaction with the 5-ht (serotoninergic) system and is independent of narcotic or cholinergic agonists. the antianalgetic stress hormone, acth, also does not interfere with this action. physostigmine does not interfere with the anaesthetic state when given during general anaesthesia. it attenuates several withdrawal states, especially alcohol delirium, opiate and nitrous oxide withdrawal syndromes. the drug may offer a protective mechanism against hypoxic damage of the brain and may also be beneficial in amnestic syndromes and sleep disorders. physostigmine produces central and peripheral cardiovascular stimulation. it has been shown that physostigmine can be useful in prevention and treatment of postanaesthetic behavioural disturbances following anaesthesia with propofol. number of indications for use of physostigmine has increased considerably

you might want to grab this article from your library (pubmed will answer many of your questions) acta anaesthesiol scand. 1981 oct;25(5):387-90.[color=#336699]related articles, [color=#336699]links comparison of physostigmine and neostigmine for antagonism of neuromuscular block. salmenpera m, nilsson e. the ability of physostigmine alone and in combination with neostigmine to reverse d-tubocurarine-induced neuromuscular block was evaluated in surgical patients. the relaxation was maintained at a level of 90% twitch suppression during balanced anesthesia, and antagonism was attempted with physostigmine 1.5 mg x 3; neostigmine 0.5 mg x 3; neostigmine 1.0 mg x 3; or with a combination of physostigmine 0.75 mg and neostigmine 0.5 mg x 3. the measured parameters included the twitch force or emg amplitude of the adductor pollicis brevis muscle after supramaximal 0.1 hz stimulation and fading of these responses after repetitive 2 and 50 hz stimuli. although the restitution rate of twitch height and emg amplitude were essentially the same with both antagonists, there was a considerable time-lag in regeneration of the fades after repetitive stimuli with physostigmine as compared with the neostigmine group. the addition of physostigmine to a subeffective dose of neostigmine resulted in antagonism comparable to that seen in other groups. the clinical antagonism was satisfactory in all patients receiving physostigmine. the divergence of relaxation-indicating parameters (twitch responses and fades) after physostigmine suggests dissimilar modes of action of two antagonists at the neuromuscular junction

What is the dose of atropine?

Is the practioner using atropine or robinul in the mix? That might explain the physostigmine. Mike

Amen

Haven't been on in awhile, just wanted to say congrats and if anyone has any questions or needs anything, call me (some have my number) or drop a line. For those applying to the supplementary board, if there is anything I can help you with I can give it a shot. Mike

YOU DA MAN, Mike

I gotta say I am sorry your in that situation. The only thing I can add is that with the Army, if your motivated enough, you can "reinvent" yourself every 2-3 years. You can come in, work for a bit, apply for a school - graduate and work for a bit - and apply for more schooling. You do deploy but you can work around that depending on what you want out of nursing. I know that if love the military but the Navy is treating you poorly, branch transfers can be done (to the Army or Air Force). Hope it gets better, Mike

I can add a little bit here, CRNAs: 1) PROFIS = 6 months BOG 2) FORSCOM = You return when your unit does (whenever that may be). Mike

Yoga, I have been the anesthetist for several GS's in the military who have performed these procedures and that sounds whacky! I never have worked with anyone who has done that in the service (was he Army?) Mike

Just another technique 1 liter of air contains roughly 210 ml O2 1 liter of O2 contains 1000 ml O2 1 liter of N2O contain 0 ml O2 example using air So 2 Liter of air and 1 liter of O2 - 2 * 210 = 420 - 1 * 1000 = 1000 1420/3000 = .473 (47% O2)

I am a CRNA in the Army and back in school for my PhD in Neuroscience on the Army's bill (I get my education, they get a few more years....fair trade). My family and I live in MD and I attend the Uniformed Services University in Bethesda. Take Care and Good Luck, Mike

http://bhpr.hrsa.gov/nursing/scholarship/bulletin.htm#service You might find this link useful. Mike

Thanks for the support, The good thing is that if the wire is of sufficient length, you will be able to try a few sizes if need be. Take Care, Mike

nope, not yet, I will be the first to let y'all know.:) Mike

"the u.s. army graduate program in anesthesia nursing, or usagpan, is pleased to announce that the university of texas nurse anesthesia program board has met, and has accepted 37 army applicants for the fy 07 nurse anesthesia class. what this means to all the bright, motivated nurse corps officers that are reading this, and their supervisors, is that there will be a second board held by ut sometime in january 2006. the usagpan army student capacity is 44 students. so, there are 7 additional slots that need to be filled by qualified applicants. the usagpan program and the army nurse corps leadership acknowledge that trying to submit a packet from iraq or other forward deployed locations is difficult. this second board provides a well deserved opportunity for additional applicants to get their packets in and compete for a seat in one of the best nurse anesthesia programs in the nation. when meeting with officers attending the captains career course, it was brought to our attention that there are some misconceptions about applying to and being a student in the usagpan program. the first is that you have to work in an icu, or be an 8a to apply to our program. this is false. active duty army nurse corps officers that work in an acute care setting, including the wards, labor and delivery, the post-anesthesia care unit, etc. can all apply. your chief nurses, in conjunction with the department of nursing science at ft. sam houston, will arrange appropriate clinical experiences to help you gain the knowledge and experience you'll need to succeed in our program" there are 7 slots still open for next year if anyone is interested. pm me if you want my information or goto www.dns.amedd.army.mil/crna for more information. i can give information on how to do an interservice transfer as well. mike