LESSER KNOWN FACTS ABOUT A WELL KNOWN PERSON : PROPOFOL

✔️Pain on injection due to Propofol is INCREASED BY

🔹rapid injection

🔹lower temperature of the propofol 

🔹the use of an IV carrier infusion to dilute the propofol as it enters the vein

✔️ Propofol is almost entirely un-ionised in solution

✔️ The soya bean oil and egg components are denatured by processing and there is no evidence that propofol should be avoided in patients with allergies to eggs or soya

Reference: Pandit J. Intravenous anaesthetic agents. Anaesth Intens Care Med 2007; 9 (4): 154–9 

#Propofol , #EggAllergy , #anesthesia

A FEW CLINICAL SCENARIOS IN WHICH ECHOCARDIOGRAPHY CAN HELP THE #Anesthesiologist SIGNIFICANTLY IN THE CARE OF PATIENTS COMING FOR NON-CARDIAC SURGERIES

👁 During Pre Anesthetic Evaluation, to rule out structural heart disease. For e.g. A recent study identified a 12% incidence of moderate to severe aortic stenosis in unselected fractured neck of femur patients.

👁 When the nature of the planned surgery might result in severe haemodynamic, pulmonary or neurological compromise e.g. Neurosurgical procedures in the semi-sitting position, liver transplantation, scoliosis surgery, endovascular aortic stent graft placement and resection of renal tumours that extend into the inferior vena cava

👁 When the patient’s known or suspected cardiovascular pathology might result in severe haemodynamic, pulmonary or neurological compromise e.g. patients with dynamic outflow tract obstruction secondary to hypertrophic cardiomyopathy and those with ventricular assist devices in place.

👁Trans Esophageal Echo (TEE) can assess the volume status intraoperatively

👁  Persistent unexplained hypotension : Causes can be LV systolic or RV dysfunction, severe MR , dynamic LV outflow obstruction, cardiac tamponade , aortic dissection ( TEE is the technique of choice) , large pleural effusion etc

👁 Persistent unexplained hypoxaemia : A Patent Foramen Ovale can cause this

Reference: AAGBI Core Topics in Anaesthesia 2015 , Echocardiography and Anaesthesia, Jonathan H. Rosser and Nicholas J. Morgan-Hughes

HAVE YOU SEEN PERSISTENT UNEXPLAINED HYPOXAEMIA IN ADULT PATIENTS ❓ ONE IMPORTANT D.D. IS PFO❗️

▪️Persistent unexplained hypoxaemia can result from the presence of a Patent Foramen Ovale (PFO)

▪️A quarter of young adults have a #PFO

▪️Actually there is no deficiency of atrial septal tissue per se, in such cases

▪️In the absence of left atrial dilation, the defect functions as a flap valve, only allowing right-to-left flow. 

▪️Normally, left atrial pressure exceeds right atrial pressure and no shunting occurs. 

▪️ However, if right-sided pressures increase, right-to-left shunting and therefore potential hypoxaemia can occur. 

▪️ Acutely, this may become evident in such patients 

✔️during #ventilator asynchrony 

✔️with maintenance of high positive end-expiratory pressures (PEEP) during mechanical ventilation   

✔️in #ARDS patients with acute cor pulmonale or with right ventricular systolic dysfunction, particularly as part of the right ventricular infarction syndrome. 

▪️The diagnosis should be considered in any intensive care patient in whom the degree of hypoxaemia appears disproportionate, and should be detectable by colour Doppler. 

▪️Management might include a counterintuitive decrease in positive end-expiratory pressure ( #PEEP ) and the re-establishment of spontaneous ventilation.

Reference: AAGBI Core Topics in Anaesthesia 2015 , Echocardiography and Anaesthesia, Jonathan H. Rosser and Nicholas J. Morgan-Hughes