True anaphylaxis is a type 1 hypersensitivity reaction where histamine, serotonin, leukotrienes, and other mediators are released from basophils and mast cells via an IgE-mediated mechanism. Although patients classically present with cutaneous findings (urticaria, erythema, etc.), respiratory symptoms (wheezing, stridor), gastrointestinal disturbances, tachycardia, and hypotension are also frequently associated with…
Total intravenous anesthesia (TIVA) traditionally refers to general anesthesia maintained by intravenous medications without using inhaled volatile (“gas”) anesthetics. To safely accomplish this, one must understand the pharmacokinetics involved with maintaining an appropriate plasma/brain concentration for a given medication (propofol, dexmedetomidine, opioids, ketamine, etc.) and the synergy/side effects of these…
Metoprolol (Lopressor) is a selective beta-1 receptor blocker used primarily to decrease heart rate (chronotropy) and cardiac contractility (inotropy) in those with anginal chest pain, acute myocardial infarctions, supraventricular tachycardias, and even off-label for anxiety disorders.
Nitroglycerin (NTG) is short-acting venodilator (vasodilator at higher doses) which, like all nitrates, is converted to nitric oxide to exert its effects. In medicine, NTG is routinely used to improve the mismatch between cardiac oxygen supply and demand by dilating the coronary arteries as well as the large venous capacitance…
Glycemic control in the perioperative and ICU settings is a crucial consideration for me! As a cardiac anesthesiologist, I routinely start my patients on insulin infusions with a small bolus depending on the severity of their hyperglycemia. Unlike conscious patients that may become tremulous, diaphoretic, or even pass out, patients…
Liposomal bupivacaine (Exparel) is a local anesthetic touted for the long duration of its activity. Molecules of bupivacaine are encapsulated within multivesicular liposomes composed of endogenous lipids like cholesterol and phospholipids; these liposomes undergo rearrangement to cause a slow release of bupivacaine over 2-3 days.
Celecoxib (Celebrex) is an oral, non-steroidal anti-inflammatory drug (NSAID). This class of medications typically inhibits two major isozymes: COX-1 (responsible for platelet aggregation, kidney perfusion, and gastrointestinal mucosa protection) and COX-2 (produced as a result of tissue damage to mitigate the inflammatory response). By selectively inhibiting COX-2, celecoxib tries to…
Zerbaxa (ceftolozane-tazobactam) is a potent intravenous antibiotic used for gram-negative intraabdominal and urinary tract infections resistant to more traditional antibiotics. It is active against P. aeruginosa, E. coli, and various other gram negative bugs like species of Proteus, Citrobacter, Serratia, and Salmonella.
Throughout my training, I’ve placed countless pulmonary artery (“Swan-Ganz”) catheters for cardiothoracic surgeries and in the ICU to help guide the diagnosis and response to therapy in mixed or undifferentiated shock. These PA catheters gave me various pressures (central venous, pulmonary artery, sometimes right ventricular), the ability to draw true…
