Reliable peripheral intravenous (PIV) access is essential to patient safety in the event of massive resuscitation in the operating room, so anesthesiologists tend to place cannulas in the hands as they are less likely to kink and permit more proximal placement of additional PIVs. If you blow an IV in the…
Furosemide (Lasix) is a loop diuretic that works on the Na/K/2Cl cotransporter in the thick ascending loop of Henle. It’s a medication I routinely use for patients with congestive heart failure (CHF) exacerbations who are retaining extra fluid in their distal extremities, lungs, abdomen, and other dependent areas. In the…
The indications for central venous catheters (CVCs) include invasive hemodynamic monitoring, transvenous cardiac pacing, hemodialysis, lack of peripheral venous access, administration of vasopressors, nutritional support, and in some texts…. volume resuscitation. It’s this last one that bothers me. Yes, some CVCs like multi-lumen access catheters (MAC) can be wonderful for massive resuscitation,…
Lidocaine (1 – 1.5 mg/kg) is often given intravenously prior to the induction of general anesthesia for a dual purpose – to mitigate the burning sensation of propofol (attributed to its glycerol additive) and to blunt the response to performing laryngoscopy. Let’s discuss this common practice.
As healthcare providers, we routinely rely on monitors, lab results, imaging studies, and a myriad of other diagnostic tests to diagnose new medical problems and monitor responses to therapy. Before interpreting the conclusions or results of these tests, we must ask a simple question – can you trust the test?
Asleep-awake-asleep craniotomies aim to preserve portions of the eloquent cortex – parts of the brain that are critical for speech, language, motor function, and localization. Patients are awake for brain surgery. I wanted to give a play-by-play of the anesthetic considerations.
Cardiopulmonary physiology has always been an interest of mine. I’ve previously written about how cardiac output is affected by spontaneous versus positive pressure ventilation, and now I want to discuss how pulmonary vascular resistance (PVR) is affected by ventilation.
Epinephrine (adrenaline). Norepinephrine (noradrenaline). Isoproterenol. Vasopressin. Dopamine. Phenylephrine. Dobutamine. Milrinone. Calcium.
In most academic settings, the operating room is composed of the surgical team (attending, fellow, residents), anesthesia team (attending, fellow, residents, nurses), techs (scrub tech, anesthesia tech), circulating nurses, students, observers, and most importantly, the patient. The surgery attending is usually the captain of this proverbial ship; however, a delicate interplay between…
Routinely utilized in ICUs, operating rooms, and telemetry floors, the pulse oximeter (“pulse ox“) is perhaps the single greatest monitoring advancement in the modern medical era. It relies on the fact that oxyhemoglobin and deoxyhemoglobin absorb light at two different peak wavelengths. Without getting into too much detail, an algorithm is…