Anesthesia

Topical application of local anesthetic agent can be accomplished orally (as a swish and swallow) or by transtracheal deposition into the tracheal lumen. However, these techniques may blunt the glottic and cough reflex, increasing the patient’s susceptibility to aspiration. The gag reflex can be further controlled by supplementary nerve blocks to the lingual branch of […]

Patients who have had a laryngospasm may be susceptible to secondary pulmonary edema. This can be the result of negative alveolar pressure of an expanding diaphragm against a closed glottis, or due to barotrauma from positive pressure ventilation. Pulmonary trauma arising from laryngospasm may become clinically evident hours after the spasm. In this case, signs

Large doses of prilocaine, generally greater then 600 mg, can result in methemoglobinemia in selected patients. Intravenous doses of articaine have been reported to cause similar problems. This occurs as a result of one of the metabolites of the drug converting reduced hemoglobin to methemoglobin. The patient will experience cyanosis with dark blood. Pulse oximetry

An increase in heart rate is usually the earliest and most consistent sign to be detected. An increase in end-tidal CO2 is usually the most sensitive sign in detecting malignant hyperthermia. While increase temperature and muscle rigidity are hallmark signs of malignant hyperthermia, these manifestations are less sensitive and may not present as early as

Blood Pressure Cuff Size: Accurate Measurement and Common Errors Accurate blood pressure measurement depends not only on proper technique, but also on correct blood pressure cuff size. Improper cuff selection is a common and preventable cause of falsely abnormal blood pressure readings in both outpatient and perioperative settings. When selecting a blood pressure cuff, two

Venous Air Embolism: Pathophysiology, Volumes, and Clinical Effects A venous air embolism (VAE) occurs when air enters the systemic venous circulation and travels to the right heart and pulmonary vasculature. Although uncommon, VAE is a potentially catastrophic perioperative complication that can rapidly lead to cardiovascular collapse if not promptly recognized and treated. Critical Volumes of

Airway Evaluation: Key Concepts for Safe Intubation and Anesthesia By Dr. Paul Mirdamadi A thorough airway evaluation is a critical component of safe anesthesia delivery. Proper positioning, accurate airway classification, and recognition of pediatric anatomic differences allow clinicians to anticipate difficulty, select appropriate equipment, and minimize complications during intubation. This article reviews essential concepts in

Risk Factors for Aspiration: Anesthesia and Surgical Considerations Pulmonary aspiration of gastric contents is a serious perioperative complication that can lead to aspiration pneumonitis, pneumonia, hypoxia, and respiratory failure. Identifying patients at increased risk for aspiration is a critical component of pre-anesthetic evaluation, particularly in office-based anesthesia and maxillofacial surgery. Aspiration risk is influenced by

Bispectral Index (BIS): Interpreting Depth of Anesthesia The Bispectral Index (BIS) is an electroencephalogram (EEG)-derived parameter used to assess the depth of sedation and anesthesia. It provides a numerical value that helps guide anesthetic dosing, minimize awareness, and avoid excessive anesthetic depth. BIS values range from 0 to 100, with higher numbers reflecting greater levels

ASA NPO Guidelines: Preoperative Fasting for Safe Anesthesia Induction Proper preoperative fasting is critical for reducing the risk of pulmonary aspiration during anesthesia. The American Society of Anesthesiologists (ASA) NPO guidelines provide evidence-based recommendations that define safe minimum fasting intervals prior to sedation and general anesthesia. Understanding these guidelines—and the physiologic factors that influence gastric