@sivatrainees.bsky.social
0.2mg/kg bolus has no EEG effect
(See image)
0.3mg/kg may have an effect but I feel clinically un likely
0.5mg/kg often will induce EEG changes that are associated with an rise in BIS index
If bolusing and concerned about rise in BIS value, give during a period of surgical stability
(See image)
0.3mg/kg may have an effect but I feel clinically un likely
0.5mg/kg often will induce EEG changes that are associated with an rise in BIS index
If bolusing and concerned about rise in BIS value, give during a period of surgical stability
July 8, 2025 at 3:28 AM
0.2mg/kg bolus has no EEG effect
(See image)
0.3mg/kg may have an effect but I feel clinically un likely
0.5mg/kg often will induce EEG changes that are associated with an rise in BIS index
If bolusing and concerned about rise in BIS value, give during a period of surgical stability
(See image)
0.3mg/kg may have an effect but I feel clinically un likely
0.5mg/kg often will induce EEG changes that are associated with an rise in BIS index
If bolusing and concerned about rise in BIS value, give during a period of surgical stability
NAP4 had an overrepresentation of junior anaesthetists involved in aspiration events.
I'd argue that teaching a 'standardish' RSI technique to your less experienced team members gives them a baseline of safety; alone, in a theatre, in the middle of the night.
I'd argue that teaching a 'standardish' RSI technique to your less experienced team members gives them a baseline of safety; alone, in a theatre, in the middle of the night.
June 4, 2025 at 2:11 PM
NAP4 had an overrepresentation of junior anaesthetists involved in aspiration events.
I'd argue that teaching a 'standardish' RSI technique to your less experienced team members gives them a baseline of safety; alone, in a theatre, in the middle of the night.
I'd argue that teaching a 'standardish' RSI technique to your less experienced team members gives them a baseline of safety; alone, in a theatre, in the middle of the night.
Ketamine has a VERY different EEG effect than propofol or the vapours
To avoid confusion, wait for a period of surgical / anaesthetic stability before giving a bolus
If you're really worried you could always give less - 0.2mg/kg appears to have no effect on BIS values. [3]
11/12
To avoid confusion, wait for a period of surgical / anaesthetic stability before giving a bolus
If you're really worried you could always give less - 0.2mg/kg appears to have no effect on BIS values. [3]
11/12
December 7, 2024 at 2:41 PM
Ketamine has a VERY different EEG effect than propofol or the vapours
To avoid confusion, wait for a period of surgical / anaesthetic stability before giving a bolus
If you're really worried you could always give less - 0.2mg/kg appears to have no effect on BIS values. [3]
11/12
To avoid confusion, wait for a period of surgical / anaesthetic stability before giving a bolus
If you're really worried you could always give less - 0.2mg/kg appears to have no effect on BIS values. [3]
11/12
BIS drops to <60 over several minutes (can takes 1h !)
As the bolus fades, propofols alpha/ delta pattern returns
So
If you give ketamine as analgesia under GA
- The EEG may change significantly
- BIS may >60
- Just because BIS >60 doesn't mean the patient is 'waking up'
10/12
As the bolus fades, propofols alpha/ delta pattern returns
So
If you give ketamine as analgesia under GA
- The EEG may change significantly
- BIS may >60
- Just because BIS >60 doesn't mean the patient is 'waking up'
10/12
December 7, 2024 at 2:41 PM
BIS drops to <60 over several minutes (can takes 1h !)
As the bolus fades, propofols alpha/ delta pattern returns
So
If you give ketamine as analgesia under GA
- The EEG may change significantly
- BIS may >60
- Just because BIS >60 doesn't mean the patient is 'waking up'
10/12
As the bolus fades, propofols alpha/ delta pattern returns
So
If you give ketamine as analgesia under GA
- The EEG may change significantly
- BIS may >60
- Just because BIS >60 doesn't mean the patient is 'waking up'
10/12
Post Ketamine bolus - BIS goes up
(unsurprisingly)
DSA Shows
Propofol alpha / delta pattern ->
Fast oscillations in the high-beta / low-gamma range
(Initial theta wave activity too)
Slow rising BIS, >60 after 4.4 minutes
Peak BIS 10 minutes after bolus
9/12
(unsurprisingly)
DSA Shows
Propofol alpha / delta pattern ->
Fast oscillations in the high-beta / low-gamma range
(Initial theta wave activity too)
Slow rising BIS, >60 after 4.4 minutes
Peak BIS 10 minutes after bolus
9/12
December 7, 2024 at 2:41 PM
Post Ketamine bolus - BIS goes up
(unsurprisingly)
DSA Shows
Propofol alpha / delta pattern ->
Fast oscillations in the high-beta / low-gamma range
(Initial theta wave activity too)
Slow rising BIS, >60 after 4.4 minutes
Peak BIS 10 minutes after bolus
9/12
(unsurprisingly)
DSA Shows
Propofol alpha / delta pattern ->
Fast oscillations in the high-beta / low-gamma range
(Initial theta wave activity too)
Slow rising BIS, >60 after 4.4 minutes
Peak BIS 10 minutes after bolus
9/12
And that's exactly what we see with a low dose bolus.
Activity in the high beta - low gamma range (25 - 32 Hz)
Under anaesthesia, this high frequency activity can be interpreted by the BIS as a lighter plane of anaesthesia
7/12
Activity in the high beta - low gamma range (25 - 32 Hz)
Under anaesthesia, this high frequency activity can be interpreted by the BIS as a lighter plane of anaesthesia
7/12
December 7, 2024 at 2:41 PM
And that's exactly what we see with a low dose bolus.
Activity in the high beta - low gamma range (25 - 32 Hz)
Under anaesthesia, this high frequency activity can be interpreted by the BIS as a lighter plane of anaesthesia
7/12
Activity in the high beta - low gamma range (25 - 32 Hz)
Under anaesthesia, this high frequency activity can be interpreted by the BIS as a lighter plane of anaesthesia
7/12
Ketamine is anaesthetically weird
Low doses act on NMDA receptors that inhibit inhibitory interneurons (double negative)
This activates excitatory neurons - Not in a nice coordinated manner - Cortex, amygdala, hippocamp etc talk to one another but information is garbled.
5/12
Low doses act on NMDA receptors that inhibit inhibitory interneurons (double negative)
This activates excitatory neurons - Not in a nice coordinated manner - Cortex, amygdala, hippocamp etc talk to one another but information is garbled.
5/12
December 7, 2024 at 2:41 PM
Ketamine is anaesthetically weird
Low doses act on NMDA receptors that inhibit inhibitory interneurons (double negative)
This activates excitatory neurons - Not in a nice coordinated manner - Cortex, amygdala, hippocamp etc talk to one another but information is garbled.
5/12
Low doses act on NMDA receptors that inhibit inhibitory interneurons (double negative)
This activates excitatory neurons - Not in a nice coordinated manner - Cortex, amygdala, hippocamp etc talk to one another but information is garbled.
5/12
Summary up front
- 0.5mg/kg causes stereotypical EEG changes that manifest as a high BIS number
- If you bolus intraop, do it when everything is stable
- <0.2mg/kg probably won't have too much effect on the EEG
3/12
- 0.5mg/kg causes stereotypical EEG changes that manifest as a high BIS number
- If you bolus intraop, do it when everything is stable
- <0.2mg/kg probably won't have too much effect on the EEG
3/12
December 7, 2024 at 2:41 PM
Summary up front
- 0.5mg/kg causes stereotypical EEG changes that manifest as a high BIS number
- If you bolus intraop, do it when everything is stable
- <0.2mg/kg probably won't have too much effect on the EEG
3/12
- 0.5mg/kg causes stereotypical EEG changes that manifest as a high BIS number
- If you bolus intraop, do it when everything is stable
- <0.2mg/kg probably won't have too much effect on the EEG
3/12
1st SIVATrainee - BlueSky Thread!
pEEG and ketamine
If youve spent any time around TIVA and EEG
You'll know that ketamine can increase the BIS number - Perhaps you never use ketamine because every time you do your processed EEG keeps telling you the patient's 'awake'
1/12
pEEG and ketamine
If youve spent any time around TIVA and EEG
You'll know that ketamine can increase the BIS number - Perhaps you never use ketamine because every time you do your processed EEG keeps telling you the patient's 'awake'
1/12
December 7, 2024 at 2:31 PM
1st SIVATrainee - BlueSky Thread!
pEEG and ketamine
If youve spent any time around TIVA and EEG
You'll know that ketamine can increase the BIS number - Perhaps you never use ketamine because every time you do your processed EEG keeps telling you the patient's 'awake'
1/12
pEEG and ketamine
If youve spent any time around TIVA and EEG
You'll know that ketamine can increase the BIS number - Perhaps you never use ketamine because every time you do your processed EEG keeps telling you the patient's 'awake'
1/12
SALG Patient Safety Update has released
One case reports stood out
Relevant after our 'TIVA in a hyperbaric chamber' by Craig Holdstock
#SIVA24
One of the few NHS funded indications for hyperbaric oxygen therapy. Delaying can be detrimental
🔗 tinyurl.com/5564rezu
#salgpatientsafety @RCoANews
One case reports stood out
Relevant after our 'TIVA in a hyperbaric chamber' by Craig Holdstock
#SIVA24
One of the few NHS funded indications for hyperbaric oxygen therapy. Delaying can be detrimental
🔗 tinyurl.com/5564rezu
#salgpatientsafety @RCoANews
December 2, 2024 at 4:12 PM
SALG Patient Safety Update has released
One case reports stood out
Relevant after our 'TIVA in a hyperbaric chamber' by Craig Holdstock
#SIVA24
One of the few NHS funded indications for hyperbaric oxygen therapy. Delaying can be detrimental
🔗 tinyurl.com/5564rezu
#salgpatientsafety @RCoANews
One case reports stood out
Relevant after our 'TIVA in a hyperbaric chamber' by Craig Holdstock
#SIVA24
One of the few NHS funded indications for hyperbaric oxygen therapy. Delaying can be detrimental
🔗 tinyurl.com/5564rezu
#salgpatientsafety @RCoANews
December 2, 2024 at 3:22 PM
3rd and finally @cannula_service
"Mirror mirror on the wall, which TCI model is the fairest of them all?"
"Mirror mirror on the wall, which TCI model is the fairest of them all?"
November 29, 2024 at 11:47 AM
3rd and finally @cannula_service
"Mirror mirror on the wall, which TCI model is the fairest of them all?"
"Mirror mirror on the wall, which TCI model is the fairest of them all?"
November 29, 2024 at 11:46 AM
November 29, 2024 at 11:46 AM
Some great questions coming through in the panel discussion
BAS (UK Antarctica society) do not require and appendicectomy. Aus & US do!
#SIVA24
BAS (UK Antarctica society) do not require and appendicectomy. Aus & US do!
#SIVA24
November 29, 2024 at 10:39 AM
Some great questions coming through in the panel discussion
BAS (UK Antarctica society) do not require and appendicectomy. Aus & US do!
#SIVA24
BAS (UK Antarctica society) do not require and appendicectomy. Aus & US do!
#SIVA24
Terrifying tales from Kat Ganly Shackleton's ill fated expedition
Toes amputated due to frostbite in an upturned boat -come operating theatre
Penguin skins were burnt in order to heat and vapourise the chlorofirm
Mr Chippy - The cat also pictured
Toes amputated due to frostbite in an upturned boat -come operating theatre
Penguin skins were burnt in order to heat and vapourise the chlorofirm
Mr Chippy - The cat also pictured
November 29, 2024 at 10:14 AM
Terrifying tales from Kat Ganly Shackleton's ill fated expedition
Toes amputated due to frostbite in an upturned boat -come operating theatre
Penguin skins were burnt in order to heat and vapourise the chlorofirm
Mr Chippy - The cat also pictured
Toes amputated due to frostbite in an upturned boat -come operating theatre
Penguin skins were burnt in order to heat and vapourise the chlorofirm
Mr Chippy - The cat also pictured
Next up AntarcTIVA? Katherine Gamly on TIVA and the history of anaesthesia in the Antarctic.
@katganly
@katganly
November 29, 2024 at 10:06 AM
Next up AntarcTIVA? Katherine Gamly on TIVA and the history of anaesthesia in the Antarctic.
@katganly
@katganly
VL is going to be 1st line in space
Thankfully we won't have a video/direct debate on our mission to mars
Current studies out doing nasendoscopies in space
#SIVA24
Thankfully we won't have a video/direct debate on our mission to mars
Current studies out doing nasendoscopies in space
#SIVA24
November 29, 2024 at 9:35 AM
VL is going to be 1st line in space
Thankfully we won't have a video/direct debate on our mission to mars
Current studies out doing nasendoscopies in space
#SIVA24
Thankfully we won't have a video/direct debate on our mission to mars
Current studies out doing nasendoscopies in space
#SIVA24