1st Arch 2nd arch 3rd arch 4th Arch 6th Arch Notes -a Massive list of M’s –Second for Smiles -think Glossopharyngeal nerve -Swallowing + The exceptions to the 6th arch below -Speaking (Laryngeal) Nerve –Maxillary and Mandibular nerves –Seventh nerve (facial nerve) –Glossopharyngeal nerve -Superior Laryngeal (branch of vagus) -Recurrent laryngeal (branch of vagus) Artery –Maxillary artery –Stapedial artery and hyoid […]
5mL/kg required for significant injury (sock or cardiac arrest) Complication have been reports with 20 mL Rapid entry of large volumes of air entering the systemic venous circulation puts a substantial strain on the right ventricle, causing rise in pulmonary artery pressure and increasing pulmonary (RV) outflow obstruction. In turn, decreases pulmonary venous return
Venous Air Embolism Read Post »
Metoclopramide stimulates gastric emptying, attenuates activity of the vomiting center and increases gastroesophageal sphincter tone. It must be administered at least 20 minutes prior to induction and its effect is decreased if administered in conjunction with an opioid. It acts on the dopamine receptor in the chemoreceptor trigger zone and thus can cause extrapyramidal effects.
Anti-Emetic Medications Read Post »
Drug with ↓ solubility in blood = rapid induction and rapid recovery (NO ↓ solubility; Halothane ↑ solubility) Arteriovenous gradient = solubility in blood Drug with ↑ solubility in lipids = ↑ potency = 1/MAC MAC = Minimum Alveolar Concentration required to prevent 50% of subjects from moving in response to a noxious stimulus High
Pharmacodynamics & Pharmacokinetics Read Post »
Sniffing Position Physiologically aligns: oral axis pharyngeal axis laryngeal axis Malampati Classification Class 1: Soft palate, uvula, tonsillar pillars can be seen Class 2: As above except tonsillar pillars are not seen Class 3: Only base of uvula is seen Class 4: Only tongue and hard palate can be seen. Cormack-Lehane Views Grade 1: full glottic exposure Grade 2: only posterior
GERD Pregnancy Trauma Diabetes Mellitus Recent oral intake Bowel obstruction Intra-abdominal pathology Obesity Aspiration prophylaxis: agents which decrease the volume and/or acidity of gastric secretions (ranitidine, sodium citrate) Metoclopramide: increase gastric emptying and increase esophageal sphincter tone Parkinson’s’ disease is a neurodegenerative disease characterized by a loss of dopaminergic neurons in the substantia nigra
Risk Factors for Aspiration Read Post »
100: awake 70: moderate sedation 40-60: adequate hypnotic effect for general anesthesia
Bispectral Index (BIS) Read Post »
Safe induction according to American Society of Anesthesiologists Guidelines 2h – clear liquids (water, soda pop, coffee without creamer, fruit juice without pulp) 4h – human milk 6h – light solids (non-meat and non-fat) and non-clear liquids (non-human milk products and formula) 8h – fat and meats Gastric emptying influenced by volume (distention), osmolarity
ASA NPO Guidelines Read Post »
ACE Inhibitors & ARBS ACE inhibitors and angiotensin receptor antagonists should be held the day of surgery. Peri-induction hypotension can result from the loss of sympathetic tone associated with anesthesia induction superimposed upon renin-angiotensin system (RAS) blockade. The vasopressin system is the only intact system left to maintain BP, and vasopressin release is not a
Pre-Operative Medications Modifications Read Post »
Hemostatic Agents Article: Comparison of Hemostatic Agents used in Vascular Surgery Surgiflo Sterile and absorbable hemostatic porcine gelatin matrix that is mixed with thrombin JMI (a protein substance produced through the interaction of thrombin of bovine origin and calcium chloride). FloSeal Bovine gelatin matrix, calcium chroride and plasma derived human thrombin Gelatin granules absorb blood and
