Nic B Foss
@nicolaibangfoss.bsky.social
Anaesthesia. Research in perioperative medicine, haemodynamics. Denmark. Here for medical talk and the state of the world.
Never give atropine to opioid induced bradycardia - it is completely harmless
September 16, 2025 at 9:52 AM
Never give atropine to opioid induced bradycardia - it is completely harmless
Yes again - but whether we are actuallt masking or preventing is not really solved by this - delirum seems to be triggered by inflammation or cerebral ischaemia...Both will give a NE response
September 14, 2025 at 7:46 AM
Yes again - but whether we are actuallt masking or preventing is not really solved by this - delirum seems to be triggered by inflammation or cerebral ischaemia...Both will give a NE response
Reposted by Nic B Foss
Australians putting up our hands re anaphylaxis with rocuronium.
We see in multiple times a year just at my institution.
We are all absolute experts at diagnosis and management.
I have assisted in at least 6 in the past 10 years.
The rapid administration of adrenaline saves lives.
We see in multiple times a year just at my institution.
We are all absolute experts at diagnosis and management.
I have assisted in at least 6 in the past 10 years.
The rapid administration of adrenaline saves lives.
a woman is waving her hand in front of a purple background and saying `` oh pick me '' .
ALT: a woman is waving her hand in front of a purple background and saying `` oh pick me '' .
media.tenor.com
September 8, 2025 at 11:40 PM
Australians putting up our hands re anaphylaxis with rocuronium.
We see in multiple times a year just at my institution.
We are all absolute experts at diagnosis and management.
I have assisted in at least 6 in the past 10 years.
The rapid administration of adrenaline saves lives.
We see in multiple times a year just at my institution.
We are all absolute experts at diagnosis and management.
I have assisted in at least 6 in the past 10 years.
The rapid administration of adrenaline saves lives.
Alf is far inferior to Remi for this. I mainly caution that if you do not want to give sufficient dose of remi and propofol, then you should relax. Besides this we dont really see problems with it, and we train a lot of new doctors every year
September 8, 2025 at 9:59 PM
Alf is far inferior to Remi for this. I mainly caution that if you do not want to give sufficient dose of remi and propofol, then you should relax. Besides this we dont really see problems with it, and we train a lot of new doctors every year
It is about whether you think you can anaesthetize the patient, or whether you need the patients stress to control haemodynamics.....😊
September 8, 2025 at 9:29 PM
It is about whether you think you can anaesthetize the patient, or whether you need the patients stress to control haemodynamics.....😊
Well, it has been shown that haemodynamic max out at 5, you can give 20 without extra effect, since it works via sympatholysis. Bradycardia and hypotension is not a problem if you have a vasopressor. The key is being proficient at haemodynamics.
September 8, 2025 at 9:29 PM
Well, it has been shown that haemodynamic max out at 5, you can give 20 without extra effect, since it works via sympatholysis. Bradycardia and hypotension is not a problem if you have a vasopressor. The key is being proficient at haemodynamics.
Exactly, as I wrote: This discussion started with stating NMB is never a free lunch, neither when discussing awareness or postop. pulmonary complications - NMB is one of the main risks for both. And I have not even started on anaphylaxis to both NMB and Suggammadex
www.thelancet.com/journals/lan...
www.thelancet.com/journals/lan...
Lancet
www.thelancet.com
September 8, 2025 at 8:52 PM
Exactly, as I wrote: This discussion started with stating NMB is never a free lunch, neither when discussing awareness or postop. pulmonary complications - NMB is one of the main risks for both. And I have not even started on anaphylaxis to both NMB and Suggammadex
www.thelancet.com/journals/lan...
www.thelancet.com/journals/lan...
Because - as this discussion started with stating - NMB is never a free lunch, neither when discussing awareness or postop. pulmonary complications - NMB is one of the main risks for both. And I have not even started on anaphylaxis to both NMB and Suggammadex
www.thelancet.com/journals/lan...
www.thelancet.com/journals/lan...
Post-anaesthesia pulmonary complications after use of muscle relaxants (POPULAR): a multicentre, prospective observational study
We showed that the use of neuromuscular blocking drugs in general anaesthesia is associated
with an increased risk of postoperative pulmonary complications. Anaesthetists must
balance the potential be...
www.thelancet.com
September 8, 2025 at 8:49 PM
Because - as this discussion started with stating - NMB is never a free lunch, neither when discussing awareness or postop. pulmonary complications - NMB is one of the main risks for both. And I have not even started on anaphylaxis to both NMB and Suggammadex
www.thelancet.com/journals/lan...
www.thelancet.com/journals/lan...
Bolus. It is the slow infusion that gives rigidity.
September 8, 2025 at 8:39 PM
Bolus. It is the slow infusion that gives rigidity.
No. You get rigidity with low dose. Given at this dose together with propofol I have yet to see it.
September 8, 2025 at 8:38 PM
No. You get rigidity with low dose. Given at this dose together with propofol I have yet to see it.
I am not advocating this in extreme or complex cases. You are making a strawman argumentation here
September 8, 2025 at 8:35 PM
I am not advocating this in extreme or complex cases. You are making a strawman argumentation here
I am not advocating it in all patients, but in the majority it is quite safe. If you read the meta analysis I linked it does you all the data on safety, including a lot of emergency patients. But feel free not to try.
September 8, 2025 at 8:34 PM
I am not advocating it in all patients, but in the majority it is quite safe. If you read the meta analysis I linked it does you all the data on safety, including a lot of emergency patients. But feel free not to try.
I can't remember when it was necessary. With VL we just give on the Remi.
September 8, 2025 at 5:08 PM
I can't remember when it was necessary. With VL we just give on the Remi.
Yes, but of no consequence. Low HR is associated with positive outcome in all our data. I think our fear is related to outdated methods of anaesthesia
September 8, 2025 at 5:07 PM
Yes, but of no consequence. Low HR is associated with positive outcome in all our data. I think our fear is related to outdated methods of anaesthesia
Oh well, we have not had anymore failed intubationse, and it has been standard practice at the department and most of denmark for many years. The comment on vomting is ridiculous, and the bradycardia issue is outdated - and should not be considered an issue for anyone versed in haemodynamics.
September 8, 2025 at 1:35 PM
Oh well, we have not had anymore failed intubationse, and it has been standard practice at the department and most of denmark for many years. The comment on vomting is ridiculous, and the bradycardia issue is outdated - and should not be considered an issue for anyone versed in haemodynamics.
One thing to reflect upon is that you have ceiling level sympatholysis in most with 5 mcg/kg remi and dose can be increased further with little effect - as high as 20 mcg/kg has been used in studies on haemodynamics. So if I am in doubt I go higher dose....
September 7, 2025 at 4:25 PM
One thing to reflect upon is that you have ceiling level sympatholysis in most with 5 mcg/kg remi and dose can be increased further with little effect - as high as 20 mcg/kg has been used in studies on haemodynamics. So if I am in doubt I go higher dose....
It means many inductions are closer to RSI, because there is no waiting time and thus no need for ventilation. If you are used to maintaining cardiovascular tone with high sympathetic activity, BP/HR will drop a bit more with this technique and we ofte use vasopressors.
September 7, 2025 at 4:25 PM
It means many inductions are closer to RSI, because there is no waiting time and thus no need for ventilation. If you are used to maintaining cardiovascular tone with high sympathetic activity, BP/HR will drop a bit more with this technique and we ofte use vasopressors.
I have always been guided by the Bouvet study. I use propofol 2 mg/kg and remi 5 mcg/kg together on induction as my base. between 45-60 s after induction you see the HR drop, reflecting sympatholysis and you go.
associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/...
associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/...
Optimal remifentanil dosage for providing excellent intubating conditions when co‐administered with a single standard dose of propofol
This dose–response study aimed to determine the dose of remifentanil combined with propofol 2.5 mg.kg−1 which provided excellent intubation conditions in 95% of patients. Ninety premedicated female A...
associationofanaesthetists-publications.onlinelibrary.wiley.com
September 7, 2025 at 4:25 PM
I have always been guided by the Bouvet study. I use propofol 2 mg/kg and remi 5 mcg/kg together on induction as my base. between 45-60 s after induction you see the HR drop, reflecting sympatholysis and you go.
associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/...
associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/...