Anaesthetists Handbook - MEDICAL EDUCATION at University ...

Miscellaneous issueschoice. Etomidate may be considered in certain patients with poorcardiovascular reserve.Central line insertion[Dr Cyprian Mendonca, January 2009]NICE recommends that two-dimensional (2-D) imaging ultrasoundguidance should be the preferred method for elective internal jugularvein catheterisation in adults and children [Technology Appraisalnumber 49, 2002]. This was considered at a clinical audit meeting in2006.2-D ultrasound machines for inserting central venous lines areavailable in all theatre areas, the emergency department and thecritical care units.You should learn landmark techniques in order to retain importantskills. When using the landmark technique, the department advisesthat you verify the anatomy of neck by performing an ultrasound scanbefore insertion of the catheter.Contact Dr Mendonca if you need to arrange training.Clopidogrel and surgical patients[Dr S. Radhakrishna, August 2007; appraised January 2008]These guidelines are based on current evidence. Decisions onclopidogrel usage should be taken in conjunction with surgeons andthe responsibility for cancelling clopidogrel prescriptions rests withthe surgeons.(There is a guideline in the cardiology folder on the intranet dealingwith anticoagulation or antiplatelet treatment for cardiac patientsundergoing non-cardiac surgery.)Elective Cases:1. Patients who are on clopidogrel and who have had a coronaryartery stent inserted within the year: the clopidogrel should198 Anaesthetists Handbook January 2010