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Lessons

A collection of random things I’ve learned through my training

Remifentanil

Remifentanil (Ultiva) is a potent (~200-300 times more than morphine), short acting, titratable narcotic infusion I use for moderate/deep sedation and maintaining general anesthetics. Unlike many drugs which rely on hepatic and/or renal…
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Rocuronium

Rocuronium is an aminosteroid nondepolarizing neuromuscular junction blocker (NMJB) I routinely use to facilitate tracheal intubation. The name rocuronium comes from the fact that it's a rapid onset -curonium (referring to its steroid…
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Milrinone

Milrinone (Primacor) is a phosphodiesterase 3 (PDE3) enzyme inhibitor I routinely use as an inodilator. That is, a drug which enhances cardiac contractility (inotropy) while decreasing vascular resistance (vasodilation).
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The Continuity Equation

The continuity equation illustrates the conservation of energy. In the case of blood flow within the (normal) heart, volumetric flow (cardiac output) at serial sites should be equal. The image shows flow velocities across the left…
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The Doppler Effect

The Doppler effect refers to a shift in frequency perceived by an object in motion relative to the source of a wave. When applying this to ultrasonography, the transducer is a stationary source of ultrasound waves of a known frequency…
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The Heart’s Fibrous Skeleton

There’s a complex yet beautiful architecture within the heart's fibrous skeleton and valvular geometry. To become a proficient perioperative echocardiographer, one must understand these spatial relationships in three dimensions and the…
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Cerebral Autoregulation

Most organ systems have some form of autoregulation to provide a steady supply of blood flow and oxygen to maintain normal physiologic function. This autoregulation is largely driven by chemical mediators to “couple” metabolic demand with…
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