Selvan Ramsamy
@selvan_ramsamy
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Joined October 2011
@doctimcook @AirwayLegend @ben_cloyd @valeriovalente 4/Point being made : MAC VL gives you superior laryngeal views than DL and superior training can get the ETT into the trachea without an introducer / Stylet.
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High neuraxial block in obstetrics: are we only seeing the tip of the iceberg? The presence of local anaesthetic in the epidural space makes the effect of subsequent intrathecal drug administration less predictable. #anaesthesia #obstetrics #pain #MedTwitter
@AllisonLeeNYC
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@selvan_ramsamy In the uk Diamorphine is the go to long acting intrathecal opioid Lipophilic and therefore much safer/better as it spreads within the csf much less than morphine….which tends to wander around I believe!
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Is Intrathecal morphine not the Gold Standard if comparing facial plane blocks .
@anesthesianews Gold standard -For major open abdominal surgery -Especially in higher risk patients -Evidence of benefits beyond pain relief generally better for TEA than any other pain relief modality (but the skills to place it reliably, and the infrastructure to make it safe on the wards
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Curious about the carbon footprint of individual items used in total intravenous anaesthesia (TIVA) and sevoflurane anaesthesia? Here's some helpful info! #anaesthesia #climate #MedTwitter
https://t.co/IoKOqV6PDw
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📘 Videolaryngoscopy is now central to safe airway management – but are we still documenting it with tools built for a different era? This article questions whether Cormack–Lehane should finally be retired for VL. #BJAEd
bjaed.org
The first videolaryngoscopes were marketed in 2001. In the two decades since, the number of models available, diversity in design and popularity have all significantly increased.1 Designs can be...
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@selvan_ramsamy I don’t see ‘an acute angle’ But maybe that’s because of positioning “Using a VL does not obviate the need for good basic airway care: -positioning -preoxygenation -paralysis -precision”
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@selvan_ramsamy The stylet should NEVER pass the glottis. ALWAYS withdraw it as the TT is advanced Tube passage improved by - proper head and neck positioning (most often neglected) - small tube (6.6.5 ID) With this difficulty is very uncommon Additional options - soft tip tube - 180 degree
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Sometimes you have to give noradrenaline in a hurry! Here are the working party recommendations for administering peripheral noradrenaline. #anaesthesia #MedTwitter
https://t.co/2QKLPWOYXl
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@DrRobbieErskine @L_D_White @amit_pawa @ajrmacfarlane @ESRA_Society @docmorne @bobfunn @GongGasGirl @ASRA_Society @diazolam @DrSleep88 @NagdevArun @rosie_hogg @MKwesiKwofie @garyschwartzmd @PeterMerjavy @Ropivacaine @canestezi @EMARIANOMD @James_Kim_MD @anesthesianews @curromir What WAS different was the duration. Mepi shortest, bupi longest, and the mix was somewhere in the middle. That was kinda eye opening...so our conclusion was: Onset will be the same no matter what, so just choose based on duration (and...is there a need for an "intermediate
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@VirtueOfNothing Or maybe putting in an SGA is better than immediate intubation……. A 2nd gen SGA which has a good oesophageal seal & a drain tube will - occupy the hypopharynx - vent regurgitated fluid - protect the airway - enable passing a gastric tube into the stomach - all while
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Wordle 1,523 6/6* Lots of drama with this one 🟨⬜⬜⬜⬜ ⬜⬜🟩⬜⬜ ⬜⬜🟩⬜⬜ ⬜🟩🟩⬜⬜ 🟨🟩🟩⬜🟨 🟩🟩🟩🟩🟩
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That’s a healthy brain pattern and well preserved under anaesthesia. Am I seeing some low power( green) in the 11-16 Hz band with EEG 14-16 Hz. Are you by any chance infusing low dose Dexmeditomidine in the background .
Advanced age can still have a robust EEG. We have a 89 yr old for hip DHS - she was under SV-LMA (Mac0.8) with FI plane block. No long acting opioids. EEg of alpha and slow-wave is reassuring for good recovery potential. The DSA has strong signal for her age. 0 burst suppress.
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1.EEG activity captured during the emergence phase shows sleep spindles,characterized by rhythmic 11–16 Hz activity. 2.Spectrogram analysis reveals the start of “unzipping”— a transition from alpha-dominant to beta-dominant frequencies,indicating arousal from deeper anaesthesia.
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This transitional pattern allows for less stimulating procedures — such as application of wound dressings or limb casts — without provoking full wakefulness or movement.
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This EEG signature reflects a neurophysiological “buffer zone” ideal for completing surgery while minimizing patient awareness or discomfort.
Great execution. I would often aim for this subMAC 0,3-0,6 Sevo DSA during emergence with eventual “unzipping”. I find the “ depth “ is enough for infiltration and dressings without patient moving . As this is sedation , the EEG pattern I look for is sleep spindles.
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It is fascinating when DSA reflects the neurophysiology of the anaesthetic agent. Here, we have a mid-aged gentleman with no medical illness for L tibial ORIF. The DSA pattern of the last 30mins of the operation showed different changes by anaesthetic agent we used.
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Just for interest , the reverse can also be done . I usually just administer the remaining induction propofol if I have titrated down SEVO too early rather than increasing the SEVO to MAC . This way the DSA pattern without the theta fill is maintained and emergence is smooth .
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Great execution. I would often aim for this subMAC 0,3-0,6 Sevo DSA during emergence with eventual “unzipping”. I find the “ depth “ is enough for infiltration and dressings without patient moving . As this is sedation , the EEG pattern I look for is sleep spindles.
The first part of DSA, we can clearly see high power of slow wave with patchy high signal at alpha frequency from the Propofol Tci. This signal was mainly blunted by Remifent effect on frontal Cortex.
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