I think I would be able to appreciate the interactions of the cardiovascular and respiratory systems a lot better if they all just used the same units! #AnSky

Main limitation is probably what you can do with positive pressure without destroying their lungs.

A popped bullae and/or pneumothorax probably isn’t good for their neuroprotection…

Though I agree, that tube shouldn’t be staying in longer than absolutely necessary and should ideally come out after the operation is finished if possible

Also if patient has traumatic subdural that could easily be fixed surgically but low GCS and needs transfer from DGH to wherever your neurosurgeons live…

I get this, but patient could easily arrive at your MTC intubated by HEMS and then you are maybe giving them a couple days neuro-protection before performing a one way extubation.

Wasn’t really convinced by lidocaine for this indication, felt much more comfortable with MAC 1.2- 1.3 and a slug of fentanyl and propofol pre-incision.

The prilocaine spinal I did for a haemorroidectomy was by far the smoothest anaesthetic for a perianal procedure.

I think there are valid safety concerns (people have died on wards from lidocaine infusions), there a other limited evidence multimodals you can use (looking at you magnesium, clonidine) and local is probably better used locally near the nerves!

Used it in ITU a couple of times, seen an infusion once intra-operatively. Tried it as a bolus once to reduce laryngospasm during a bum abscess.

Also probably depends on on your skill set. If you are someone who is very slick with a 27G spinal needle and have a good team around you to help with positioning…

But if you are digging around with a 22G quinke because you keep bending the 25G sprotte…

Sorry, one patient did remember some pain:

‘This is Dr Russell speaking’—remembers some pain in her abdomen at this time but does not know when/where this was'

Pain is different to awareness (lack of analgesia rather than a lack of amnesia), and we know that pain, even in the absence of awareness, is detrimental.

I don't think any of the patients in the isolated forearm study were in pain.

If you wanted to minimise risk of awareness, we could give our patients enough anaesthesia to be at near burst suppression, but then what would be the NNT and what harms would we cause from this?

I don’t think running light is acceptable, but in the isolated forearm studies, there were patients with awareness who seemed to be anaesthetised according to the DOA and at levels of anaesthetic drug you would expect anaesthesia.