Journal Watch: What to do when Moms pressure hits the basement

Anesthesiology as a whole has a healthy number of scientific debates a-raging: BIS or no BIS, Nerve stim vs Ultrasound, Swan vs TEE.

One debate in particular regarding the maintainence of MAP during c-sections was recently highlighted in this months Anesthesiology. CW in years past has held that uterine perfusion was best maintained with ephedrine vs phenylephrine. This was recently callled into question when Lee et. al showed no change in fetal ph after either pressor was given.

This months article by N.Kee et. al. seems to find improved outcomes with phenyleprine:

Ephedrine crosses the placenta to a greater extent and undergoes less early metabolism and/or redistribution in the fetus compared with phenylephrine. The associated increased fetal concentrations of lactate, glucose, and catecholamines support the hypothesis that depression of fetal pH and base excess with ephedrine is related to metabolic effects secondary to stimulation of fetal β-adrenergic receptors. Despite historical evidence suggesting uteroplacental blood flow may be better maintained with ephedrine, the overall effect of the vasopressors on fetal oxygen supply and demand balance may favor phenylephrine

Interesting.

"And Doc sometimes they roll..." Part 2.

I've previously blogged about intravenous access as a reason for a stay of execution here. Looks like another fella is a victim of the angiocath-challenged prison docs.

From the Associated Press:

LUCASVILLE, Ohio – Gov. Ted Strickland ordered a weeklong reprieve for a condemned inmate Tuesday after the Ohio execution team had problems finding usable veins for the lethal injection even after the inmate tried to help.

Executioners were unable for more than two hours to find veins that would accept fluid from an IV without collapsing for 53-year-old Romell Broom, who was sentenced to die for the rape and slaying of a 14-year-old Tryna Middleton in 1984. At one point, Broom covered his face with both hands and appeared to be crying.

Poor fella. If this isn't a case for the Vein Viewer, I'm not sure what is. Looks like the contraption is now a handheld device. Maybe something the Ohio Corrections Office needs to investigate further.

Iphone Apps For Anesthesia Providers (Part 3)

As this blog grows in readership I have been getting repeated requests to evaluate and/or promote iPhone applications as they are developed for the iPhone-wielding gas-passer.

A large majority of the apps are case logs and billing/cpt references. I personally have no use for such an app and have not the time or the coinage to evaluate them. I have previously highlighted iAnesthesia: Case logs since it was the first of its kind. I also found the SonoAccess app to be a really useful Regional Anesthesia app.

I've decided to make myself useful and list some of what is out there with a brief review if I've used them. Feel free to add thoughts/additions/delusions of grandeur in the comments section.

References:

• SonoAccess-excellent reference for ultrasound guided regional anesthesia. Contains links to videos, still images and cases. [Free]
• Skyscape-Baby Barash, Oxford Handbook, Omoigui's Anesthesia Drug Guide [$39.95-$69.95]
• AnestAssist PK/PD-tool used for understanding and visualizing the pharmacokinetics, pharmacodynamics, and interactions of commonly used anesthetic drugs. [$19.95]
• Medscape-drug database, interaction checker, CME on your iPhone! [Free]
• Epocrates-same as above [Free]

Coding/Billing/Case Logs:

• Gas Coder CPT database with 2009 Croswalk database [$149.99]
• A-Units Neat little app if you do your own billing. Database of CPT codes referenced with the ASA Relative Value Guide. [$74.99]

Anything missing? Feel free to add in comments.

TAB Poll #3 Results are in...whew it was a close one!

The 3rd Anesthesia Blog Poll Results are in and your favorite difficult airway device is:

#1 Glidescope (37%)

#2 Gum Elastic Bougie (35%)

I'd have to agree. That little device with their patented blade angulation has really changed airway management for us. If you or your department doesn't own one. Get one. You'll never need a bougie, light wand or a scalpel (!) again. Prayer never hurts though. Some literature about it here.