Interesting…a randomised trial compared rocuronium mixed with saline against rocuronium mixed 1:1 with 8.4% sodium bicarbonate. The principal finding was that rocuronium mixed with sodium bicarbonate 8.4% is more potent than that of rocuronium alone; it resulted in a more rapid onset time, and a prolonged recovery from the neuromuscular blockade. It is likely that … Continue reading Roc quicker when bicarb added→
Some of my pre-hospital critical care colleagues in the UK exclusively use rocuronium in preference to suxamethonium for rapid sequence induction (RSI) of anaesthesia in critically ill patients. I couldn’t see a good reason to switch although now there’s some evidence that adds to the argument. The muscle fasciculations caused by the depolarising effect of … Continue reading Less RSI desaturation with Roc→
A review article in Anesthesia and Analgesia provides a summary of the literature surrounding RSI controversies. Should a pre-determined dose of induction drug be given or should it be titrated to effect prior to giving suxamethonium? Should fast acting opioids be coadministered to blunt the pressor response? What is the optimal dose of suxamethonium? Should … Continue reading Current Controversy in RSI→
An excellent review of the current British military practice to prevent and treat the acute coagulopathy of trauma shock (ACoTS) describes pathophysiology and treatment options and offers an algorithm for management. Key components of the system (when indicated according to their algorithm) outlined include: Pre-hospital damage control shock resuscitation by a forward medical team, consisting … Continue reading Battlefield resuscitation→
Thirty-eight post-cardiac arrest patients were effectively cooled to the target temperature range of 32-34 celsius using intravenous cold saline and ice packs to groin, axillae, and neck. The ice packs were frozen 250 ml saline bags wrapped in pillow cases. If shivering occurred muscle relaxation with rocuronium was used until the target temperature was reached. … Continue reading Therapeutic hypothermia with simple measures→