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Saturday, March 6, 2010

ANAESTHESIA JOKES

CRITICISM CARE UNIT!
   
     A new surgeon has joined the department and anaesthetists were more eager to see his skills on table because they were so unpleasant about the relatively longer surgical time taken by the already existing surgeons.. So he was under the surveillance system of the anaesthetists. One month later, cases were about to get finished and one case by the same surgeon was still going on.. Two anaesthetists were posted there. One was frequently looking into his watch. The other anaesthetist commented..

"Hey man... when he is doing surgery, dont bring watches...bring CALENDARS !!!"


HOUSESURGEONS CORNER
                                                        In the Emergency Operation Theatre, which was relatively calm till noon, one housesurgeon came and said to the anesthesia M.O." Sir, there are two 'stabs'[stab injury cases] in shock, waiting in the casualty. Can you get ready for the case?". The M.O. who was taking his first duty there, got alarmed especially as he had to arrange for an extra table. Somehow he arranged both the tables, checked the defibrillator,loaded several ampoules of atropine and adrenaline and prepared dopamine infusion. And then came the patient. Of course there were two stabs; but both were in the same patient. That too, very superficial, penetrating only the soft tissues of back. We could find only one person there in shock... and that was the Anaesthesia M.O.



Thursday, December 10, 2009

Recombinant Factor VIIa

INDICATIONS:  Treatment of bleeding in Hemophilia patients.
LIKELY TO BE OF BENEFIT IN :  Patients with thrombocytopenia, Functional platelet defects, Surgical bleeding situations with dilutional or consumptive coagulopathies , Patients with impaired liver function.
MECHANISM OF ACTION : Enhance thrombin generation on activated platelets.
DOSE :  70-90 microgram/Kg OR on a non-weight basis- 4.8 mg vial to an adult [50-100 kg wt]
CLINICAL SITUATIONS :Patients receiving anticoagulant therapy : to reverse the effect of warfarin and other vitamin K antagonists, especially when treatment with vit-K alone has been found to be insufficient. DOSE - 1.2 mg or 20 microgram/ Kg
Patients with impaired liver function : Procedures like laparoscopic liver biopsy can be performed safely when it is contraindicated due to coagulopathy.
Patients with hemorrhagic stroke : Efficacy not clearly proven.
SIDE EFFECTS:  Thrombotic complications like DVT , CVA , M.I.,Pulmonary embolism ,Arterial Thrombus , Clotted devices.
CAUTION IN:  Patients with history of thrombotic complications , factor V Leiden , antiphospholipid syndrome , excessive bleeding in the setting of DIC, situations where there is generalised activation of the coagulation system e.g. Patients on ECMO and Ventricular Assist Devices.
AVOID IN: Patients being treated with activated Prothrombin complex.