Intraoperative use of IV digoxin

[BLADEMDA]

Digoxin IV in acute situations vs Pixie Dust. The former is only slightly more efficacious than the latter.

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[BLADEMDA]

SYNOPSIS: In a large perioperative patient population, norepinephrine infusion through peripheral intravenous lines did not result in any significant adverse events. However, the specific patient population, limited duration of infusion, and hospital setting may limit the generalizability of these findings.

Norepinephrine Infusion Through Peripheral Intravenous Lines: Is it…

In a large perioperative patient population, norepinephrine infusion through peripheral intravenous lines did not result in any significant adverse events. However, the specific patient population, limited duration of infusion, and hospital setting may limit the generalizability of these findings.

www.reliasmedia.com

 

[BLADEMDA]

Risk of Major Complications After Perioperative Norepinephrine Infusion Through Peripheral Intravenous Lines in a Multicenter Study - PubMed

In the current database analysis, no significant association was found between the use of peripheral intravenous norepinephrine infusions and adverse events.

pubmed.ncbi.nlm.nih.gov

Norepi and Volume to resuscitate the bleeding GI patient. Invasive line placement when possible.

 

[FiO2@21]

I don't really understand the use of precedex here. I love it for respiratory sparing purposes but it's frequently at the expense of hemodynamics. I've mentioned it here before but I did manage to do an EGD with pure precedex + benzocaine spray on a guy on HFNC 60L 100%. But he was AOx4 and since he was in the unit I didn't mind that he ended up on Norepi for a few hours. Fair trade for not getting intubated.

In this instance you're not getting much depth of anesthesia for the amount of hypotension it could get you. You had competing interests here with b/l crackles and hypotension, presumably cardiogenic shock, while actively bleeding.

I probably would have placed a new u/s IV, thrown in an arterial line, and ran low dose norepi or epi in the background while inducing with tiny doses of prop. He's already altered with EGDs are short enough that you necessarily wouldn't need any gas for maintenance after intubation anyway. I might have just ventilated with an ambu assuming you had no anesthesia machine and once the scope was done just sent him to the unit to be extubated hopefully overnight.

 

[nimbus]

I don't really understand the use of precedex here. I love it for respiratory sparing purposes but it's frequently at the expense of hemodynamics. I've mentioned it here before but I did manage to do an EGD with pure precedex + benzocaine spray on a guy on HFNC 60L 100%. But he was AOx4 and since he was in the unit I didn't mind that he ended up on Norepi for a few hours. Fair trade for not getting intubated.

In this instance you're not getting much depth of anesthesia for the amount of hypotension it could get you. You had competing interests here with b/l crackles and hypotension, presumably cardiogenic shock, while actively bleeding.

I probably would have placed a new u/s IV, thrown in an arterial line, and ran low dose norepi or epi in the background while inducing with tiny doses of prop. He's already altered with EGDs are short enough that you necessarily wouldn't need any gas for maintenance after intubation anyway. I might have just ventilated with an ambu assuming you had no anesthesia machine and once the scope was done just sent him to the unit to be extubated hopefully overnight.

Even completely healthy ASA1 patients can end up with hypotension in PACU if you give them enough precedex.