Thailand Cave Rescue - details of anesthesia and positioning during rescue

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Really cool article. RJH is a freakin dude…what a hero. I hardly remember which way to turn the vaporizer dial at altitude (thanks ABA, dumb ****ing test question) and this dude successfully anesthetizes a bunch of kids without PIV’s/ETT’s while diving under water.
 
Really cool article. RJH is a freakin dude…what a hero. I hardly remember which way to turn the vaporizer dial at altitude (thanks ABA, dumb ****ing test question) and this dude successfully anesthetizes a bunch of kids without PIV’s/ETT’s while diving under water.

Partial Pressure puts the patient to sleep. Just turn the iso/sevo dial to the same point you normally do.
 
The Australian anesthetist Dr. Harry Harris was interviewed on the ACCRAC podcast recently. Really amazing conversation:


TLDR for those who don't want to listen:
-He didnt want to do this but the kids were going to die in the next few days in the cave.
-They had to induce GA because the kids and divers would both die if anyone lost their cool. He thought that the kids would probably die of hypoventilation, water asphyxiation or laryngospasm, or hypothermia.
-The kids were all ideal patients (skinny and healthy)
-He considered different agents: precedex, clonidine, benzos, etc, but ultimately decided on ketamine since he has a lot of experience using ketamine as a sole agent in austere conditions. He could find no literature of repeat IM dosing of ketamine for maintenance GA (I think the swim took 7 hours?).
-Premedicated with ~20mcg/kg atropine to help with secretions. Gave a very small dose (unsure what) of IM midazolam for anxiolysis. Gave IM ketamine ~5mg/kg initial dose; the kids were re-dosed with ~1mg/kg q45mins by the (non-medical) rescue divers during the dive.
-During the dive, some of the kid's respiratory rates got down to 3/min. He thinks this may have been a combination of the sedatives and the cold water.
-The kids were transported with hands and feet tied behind back, floating face-down. This helped with secretions. The full face-masks had a CPAP function that probably saved their lives. It kept water out in the event of small leaks, kept airways open, and also allowed the divers to give a breath by pushing a button on the mask.
 
The Australian anesthetist Dr. Harry Harris was interviewed on the ACCRAC podcast recently. Really amazing conversation:


TLDR for those who don't want to listen:
-He didnt want to do this but the kids were going to die in the next few days in the cave.
-They had to induce GA because the kids and divers would both die if anyone lost their cool. He thought that the kids would probably die of hypoventilation, water asphyxiation or laryngospasm, or hypothermia.
-The kids were all ideal patients (skinny and healthy)
-He considered different agents: precedex, clonidine, benzos, etc, but ultimately decided on ketamine since he has a lot of experience using ketamine as a sole agent in austere conditions. He could find no literature of repeat IM dosing of ketamine for maintenance GA (I think the swim took 7 hours?).
-Premedicated with ~20mcg/kg atropine to help with secretions. Gave a very small dose (unsure what) of IM midazolam for anxiolysis. Gave IM ketamine ~5mg/kg initial dose; the kids were re-dosed with ~1mg/kg q45mins by the (non-medical) rescue divers during the dive.
-During the dive, some of the kid's respiratory rates got down to 3/min. He thinks this may have been a combination of the sedatives and the cold water.
-The kids were transported with hands and feet tied behind back, floating face-down. This helped with secretions. The full face-masks had a CPAP function that probably saved their lives. It kept water out in the event of small leaks, kept airways open, and also allowed the divers to give a breath by pushing a button on the mask.

It was a small PO dose of alprazolam prior to the ketamine/atropine injections.

But I just listened to this yesterday as well and really enjoyed it. At the end he mentioned his own podcast he started called "Real Risk" and I've started listening to it. Very cool IMO.
 
The movie was good, but I would recommend the documentery on Disney Plus over the movie.

Pretty wild how this guy was probably the only person in the world with the skillsets to save these kids.
That's why Charlie Munger always stresses multidisciplinarity.

There are a ton of great anesthesiologists, but how many are also good divers?
 
This movie and documentary should be mandatory board certification material for surgeons. Next time they give **** to anesthesiologists they can appreciate the craziness our expertise can potentially offer. Not that I would have ever even thought of this, but hey one us did it!
 
This movie and documentary should be mandatory board certification material for surgeons. Next time they give **** to anesthesiologists they can appreciate the craziness our expertise can potentially offer. Not that I would have ever even thought of this, but hey one us did it!
They will remember it for like 5 minutes.

A friend told me that there was a study that asked physicians about their comfort level with TEG. EM and mnay other specialties were under 20%. Surgeons? 90+%!

Those people are taught to believe that they are God's gift to medicine.
 
They will remember it for like 5 minutes.

A friend told me that there was a study that asked physicians about their comfort level with TEG. EM and mnay other specialties were under 20%. Surgeons? 90+%!

Those people are taught to believe that they are God's gift to medicine.
Isn't the motto for the American College of Surgeons "Often Wrong, but Never in Doubt"?
 
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