FOR THE ELDERLY
• Take into account longer duration of action in elderly • Neuromuscular blocking agents • Duration prolonged by ↑ age (if steroid based), mild hypothermia, increased density of block (train-of-four…
DRUGS RELEVANT TO PRACTICE OF ANESTHESIA
Dolasetron (Anzemet): See 5HT3 Antagonists. Droperidol (Inapsine) Indication: (1) Prevention/treatment of postoperative nausea and vomiting. Also used for (2) sedation, GA adjunct, treatment of delirium although alternate drugs are preferred…
FOR VASCULAR SURGERY
(lower should remain OFF until after reperfusion & stabilization) • Foley catheter: Goal urine output >0.5 mL/kg/hr • PRBC in the OR; may also need FFP • Management before clamping…
IN ANESTHESIA
• In pediatric patients a 20–24 gauge needle may be used for the first cannulation and then exchanged with a larger gauge over a guidewire • Proceed as described in…
INTRAOPERATIVE PROBLEMS
• Consider bronchoscopy • Consider bag ventilation • Treat underlying problem BRONCHOSPASM Causes • Preexisting reactive airway disease (asthma) • Manipulation of upper airway (oral endoscopy) • ETT with inadequate…
INHALED ANESTHETICS
MAJOR FACTORS AFFECTING UPTAKE Solubility • Partition coefficients express relative solubility of anesthetic gas at equilibrium • Lower partition coefficients imply ↓ solubility, faster equilibration of partial pressure (alveolus ↔…
ANESTHETICS
PHARMACODYNAMICS • Ionization best correlates with onset of action. LAs exist in free equilibrium in both charged (ionized) and neutral (non-ionized) forms: • The ionized form binds to the receptor…
AUTONOMIC, AND CARDIOVASCULAR DRUGS
ADRENERGIC AGONISTS General comments: Act on α, β, or dopaminergic receptors (see the table below). May cause tachycardia, hypertension, arrhythmias, myocardial ischemia, and tissue necrosis with extravasation (administer centrally, treat…
BLOCKING DRUGS
• Clinical Considerations • Indications: Bolus dosing used for rapid sequence induction when aspiration is a risk (i.e., full stomach, trauma, diabetes mellitus, hiatal hernia, obesity, pregnancy); infusion useful in…
ANESTHETICS
GENERAL PRINCIPLES • Lipophilic drugs produce rapid induction of general anesthesia • Most IV anesthetics exert effect through activation or augmentation of postsynaptic GABAA receptors (↑ chloride influx → hyperpolarization…
