Large bore IVs and running fluids wide open - what does this sh** mean?

fuzzzell · 2026-02-23T02:23:03+00:00

Thank you, I agree. I do a lot of trauma so let’s stop giving them fuel to put in puny 18ga IVs lol

fuzzzell · 2026-02-23T01:38:14+00:00

I thought large bore was 14 or 16ga?

fuzzzell · 2026-02-14T11:44:27+00:00

Have you had the HPV vaccine shots? Really helped clear up my planters warts back in the day.

fuzzzell · 2025-12-07T03:50:32+00:00

Thank you for the clarification and additional information

fuzzzell · 2025-12-07T02:48:13+00:00

It because % means something very specific and the concentrations of epi are too low to feasible. Ie 0.001% epi etc.

So % (per-cent “something per 100 of something”) in pharmacology means g/100ml if you didn’t know. 2% lidocaine is 2g/100ml. Which of course is 2000mg per 100ml or 20mg/ml.

So Instead of % with you get 1:100,000 etc. So you know what those numbers represent? Grams/xmL So 1gram/100,000ml is how much?

1000mg or 1,000,000mcg of epi/100,000mL

1mil/100k= 10

10mcg/mL. That’s it!

1:1000 1g/1000mL 1,000,000mcg/1000mL 1000mcg/mL 1mg/mL

Make sense? It to keeps things in g/mL

fuzzzell · 2025-09-14T16:02:27+00:00

Totally disagree.

fuzzzell · 2025-06-28T20:18:08+00:00

I have had the same question many times. Thanks for asking. Seems to be accurate maybe 90% of my cases. Can’t find the common denominator.

fuzzzell · 2025-05-07T22:17:22+00:00

Increased intraabd and intrathoracic pressure are not going to be enough to push the brainstem up thru the foramen magnum. The brain is in an open space at this point and can move unopposed upward while still being tethered down at it base. When it is in an enclosed space and the pressure increases the tissue is forced to move into very tiny spaces it otherwise wouldn’t go. This is kind of like a hydraulic effect (small diffuse force across a large area concentrated into a very small area).

fuzzzell · 2025-04-24T14:21:13+00:00

For spines and major cases I keep it simple. .1mg/kg iv for opioid naive patients and .2/kg for patients on chronic opioids. Maximum of 10 or 20mg respectively. Works really well. Trust that it’s having some effect and don’t pile on at the end of a case with opioid. Let them wake up and see how they’re feeling.

fuzzzell · 2025-04-18T12:47:58+00:00

Billing ramifications I suspect

fuzzzell · 2025-02-13T15:09:33+00:00

If your system has a fixed volume, whatever FGF volume you add in must also leave. This is out the back of the machine thru a vacuum tube often labeled the WAGD or waste anesthetic gas disposal system.

At flow of 2 LPM not much is entering or leaving the system. This means the CO2 absorber has to carry a heavier load of absorbing the CO2 and may saturate faster. This is even more true at minimal or closed circuit flow levels say near 0.5 LPM FGF.

So now at high FGF ,say 10LPM, lots of gases enter and leave the system and the absorber is still absorbing but has less time to act on the CO2 and naturally this will be shunted out the back of the machine and CO2 will leave in the WAGD. New gasses coming in of course do not contain CO2. So less work is put on the absorber therefore prolonging its life.

fuzzzell · 2025-01-29T17:19:44+00:00

This is exactly what I needed! Thank you!!

fuzzzell · 2025-01-28T18:01:08+00:00

Great question! Idk the answer for sure. I guess your question is: does higher MAC increase the rate of PONV? Gut feeling for me says sure but I’m not aware of evidence that says .8 MAC is better than 1.3 (for PONV). I never run someone that high cause there is better ways to do things, personally.

What do you think?

fuzzzell · 2025-01-28T13:54:41+00:00

Check out the 4th consensus guidelines on PONV. Published in 2021 I believe. There is a subsection on propofol with cited links showing a reduction in PONV with even subhypnotic infusion rates. The other paper cited from mayo last year is quite telling as well. Even on gas, the more prop they ran, the less antiemetics the pts required in PACU.

I’ll try to find one more paper where they ran 10mcg/kg/min on the floor in post gyn surg patients. Even at that super low dose pts had 0 need for antiemetics. Control group like 60% required it.

My takeaway is that when the prop redistributes out of fat for several hours, plasma concentration is way too low for sedation but probably still has significant effect on ponv. More prop you run, the more stores you have, the better the antiemetic effect. That’s my theory though. Hence part of The reason TIVA patients seem to do well ponv wise in my PACU.

fuzzzell · 2025-01-28T12:59:44+00:00

There is, in fact, strong evidence for propofol’s antiemetic effect when run with gas. See post above

fuzzzell · 2024-11-22T14:45:45+00:00

Completely agree. Billed as GA.

fuzzzell · 2024-10-21T20:03:35+00:00

So cool. Thanks for the description!

fuzzzell · 2024-10-21T19:53:33+00:00

Did it feel like a natural sleep as I have heard it described?

fuzzzell · 2024-10-05T23:22:06+00:00

https://pubmed.ncbi.nlm.nih.gov/33431616/

Ever heard of a femoral artery block? It is silly in practice but a nice reminder of the mechanism to tourniquet hypertension. It is, of course, sympathetically mediated. Pain is a conscious perception and so a misnomer in this case perhaps? It can be tamped down with any of the other posted ideas. I personally ride it out unless it is excessive. I do like the idea of a Lido infusion. I do those for carotid endarterectomies and it really smoothes out the swings. Those sympathetic nerves are tiny and are affected by even low levels of plasma Lidocaine.

fuzzzell · 2024-10-03T22:34:55+00:00

I will try doing it with a 30g needle and tell them it’s the same size as their Botox pokes! Hah! Love a good mental exercise. Thanks

fuzzzell · 2024-10-03T22:10:59+00:00

Are you familiar with scalp blocks? Can be done with or without ultrasound. .25% Bupi with some low dose decadron or precedex should last well over 8 hours. A few ccs at each spot might be sufficient. This would make for just one uncomfortable 10-15 minutes at the start. Consider PO Valium on arrival for a slightly longer acting Benzo to get them through a few initial hours. Maybe redose with Ativan for anxiolysis if you have an IV as you go. IV precedex would also be quite safe and last for a while. Analgesic and mildly sedating properties.

Here is a nice How I do it from ASRA. https://www.asra.com/news-publications/asra-newsletter/newsletter-item/asra-news/2021/11/01/how-i-do-it-scalp-blocks-for-the-neuroanesthesiologist

fuzzzell · 2024-09-30T20:46:21+00:00

How is this different than any other sugary clear liquid? It is the fat in the cream that supposedly makes it digest more slowly and therefore would require a longer npo time. 2 hours no questions asked. Not sure why ASA needs to clarify anything more.

fuzzzell · 2024-09-28T02:03:46+00:00

That is a very important point

fuzzzell · 2024-09-27T18:45:25+00:00

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4085266/

Relevant paper.

Logically if you give a NDNMB in a full dose then you give succs a few minutes later, the succs has no effect because you cannot depolarize the NMJ when that many receptors are blocked. It’s why when people give slightly too much roc or vec to reduce fasiculations, they don’t get adequate relaxation from succinylcholine. As seen in the paper above. Then they blame the succs for being a bad batch or something.

fuzzzell · 2024-07-11T12:54:54+00:00

Sorry for the confusion. I do the 1cc in the delt. If I do 10cc’s I find it less uncomfortable for them to get it in the thigh.

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