Stephens usage

RE: Stephens usage

Anthony Todd — Thu, 25 May 2017 13:40:47 GMT

[quote user="Evelyn Barbour-Hill"]Unless you mean artificially ventilating with the vaporiser still turned on? Surely not.[/quote]

er, yes unfortunately.

Just trying to think of all the things that may cause "unexplained anaesthetic deaths".....

RE: Stephens usage

Evelyn Barbour-Hill — Thu, 25 May 2017 13:23:57 GMT

[quote user="Anthony Todd"]

Some masked down caesars, on full with the sleeve down, just remembering to raise it when under...

[/quote]

Ah, the sleeve..... T.G. we don't need that any more.

[quote user="Anthony Todd"]The other thing, which might explain some anaesthetic deaths is that people ventilate a patient if apnoeic when, in fact, they are just deep, with a normal low CO2.[/quote]

I don't follow. You can't kill a patient by ventilating him, even if you are erring on the side of caution and ventilating when ventilation isn't necessary. What I do find with nurses is a desire to go on and on ventilating with a push every five seconds, with the result that spontaneous respiration doesn't return. Once instructed however, they do it better.

Unless you mean artificially ventilating with the vaporiser still turned on? Surely not.

RE: Stephens usage

Anthony Todd — Thu, 25 May 2017 13:15:13 GMT

[quote user="Evelyn Barbour-Hill"]It's true you can put the vaporiser to "induction" level (which might be 3/4, it might be 4/4, it might even be 2/4, it depends upon the size of patient) too soon, but there's no need to wait until he's "beginning to buck the endo tube" as you put it. With nice judgment and skill and proper monitoring, you can work a smooth and imperceptible changeover.[/quote]

Sure, but induction was the only time we ever had unexplained anaesthetic deaths and I've seen vets whack 'em straight onto full when the animal is still deep from the propofol or thio, so waiting, as I described, seemed to be a way round this possibility.

The other thing, which might explain some anaesthetic deaths is that people ventilate a patient if apnoeic when, in fact, they are just deep, with a normal low CO2.

[quote user="Evelyn Barbour-Hill"]No, sometimes you want to deepen anaesthesia, sometimes you want to lighten. [/quote]

Yep, fair enough, and that's the only time to flush the bag, if you want it to happen quickly.

Some masked down caesars, on full with the sleeve down, just remembering to raise it when under.....

The bean counters will love that it uses very little iso or oxygen.

RE: Stephens usage

Evelyn Barbour-Hill — Thu, 25 May 2017 13:04:13 GMT

[quote user="Anthony Todd"] The only potential caveat is the interface between induction and the "maintenance" phase [IMHO] in that operators have the vapouriser on full [or whatever %age that is] too early and actually overdose the patient so you have to wait until the induction injection has almost worn off and the patient is beginning to buck the endotube.[/quote]

It's true you can put the vaporiser to "induction" level (which might be 3/4, it might be 4/4, it might even be 2/4, it depends upon the size of patient) too soon, but there's no need to wait until he's "beginning to buck the endo tube" as you put it. With nice judgment and skill and proper monitoring, you can work a smooth and imperceptible changeover.

[quote user="Anthony Todd"]. [quote user="Martin Atkinson"] we don't rush into changing the rate of Iso but if the patient is not responding as required then you have to.[/quote] Should happen very rarely. [/quote]

No, sometimes you want to deepen anaesthesia, sometimes you want to lighten. The joy of a Stephens or Komesaroff is that you turn it down to lighten, turn it up to deepen. No fretting about or playing with percentages is necessary if the machine is used correctly. "Calibrating" the vaporiser is both pointless and meaningless.