Hi Jeffrey! So sorry to hear your case was bumped. Covid has caused so much disruption in so many areas of the hospital. It’s a very common surgery and I’m sure it’ll go well for you. I hope you’re scheduled in soon and wish you a safe and speedy recovery.

@@doctoraoifebee Thank you doctor. Appreciate your kind words. Be safe everywhere you go. Bless you for doing Gods work.

Thank you Sabelo! I certainly will. If you've topics you'd like covered please feel free to suggest.

It is not that difficult if you understand your drugs and what they do

Why thank you!

It can be quite different from hospital to hospital here depending on where they’ve bought their drugs from. Keeps you on your toes! Always checking and checking again and again. Some places use mostly vecuronium, older consultants use lots of atracurium, but most places it’s rocuronium.

@@doctoraoifebee Here it kinds of is a pick your poison thing- They will use Nimbex most places if they worry about metabolism- but between Vec. and Roc... I get the feeling they usually go for Roc. because they don't want to deal with re-constitution. Also Sux. is always on hand but the standards from place to place of when to use it are all over the place. Some people use it for all intubations- other people go right for the non-depolarizer. Some people always reverse even with a good train of four- others predect the end of the surgery and only reverse if they would still have partial paralysis by extubation.

@@DigitalAndInnovation We use cisatracurium almost exclusively for infusion in ICU here (we all dual train). Once place I worked here had two or three anaphylaxis reactions to roc and switched to using vec most of the time though I'm sure it was just an unfortunate coincidence that they'd a few reactions so close together. I have to say I've never worked with anyone that uses sux for all intubations - just the usual RSI indication and even with that younger anaesthetists will frequently use RSI doses of roc and keep the sugammadex to hand just in case. Personally I like to use sux for some RSIs and roc for others to make sure I continue to feel comfortable and fresh with both approaches. And same with the reversal - lots of different approaches here. In the hospital that I did my first year of training we did TOF on everyone and reversed everyone. The TOF was to determine whether you used neostigmine/glyco or sugammadex. Next hospital it was impossible to find a TOF machine so you frequently had to gauge on timings of doses. Personally I reverse everyone if I've given any muscle relaxant and try my best to time things well so that that relaxant is neo/glyco to keep costs down. Lovely to hear how it's done all over the world though.

Ha! We have little 3-way connectors that attach to cannulas that we call octopuses 🐙 but my Australian friends tell me that in the Southern Hemisphere they’re called a chook’s foot as they’re like a chickens claw 😄