As seniors, we oversee our junior trainees’ cases while coordinating the case flow through the operating rooms with our front desk during call shifts. While the junior residents and SRNAs check our “stat rooms” and emergent airway boxes prior to preparing for their respective cases, I’ll visit the pharmacy to grab…
Merck hosted our first journal club of the academic year yesterday evening at Sullivan’s Steakhouse. The topic: “Clinical Considerations in Neuromuscular Blockade Management” with an emphasis on sugammadex (Bridion). For years, this drug has been used in other parts of the world as a reversal for neuromuscular relaxation due to rocuronium/vecuronium.…
To minimize the risk of thrombosis on the heart-lung machine, 3-4 mg/kg IV heparin boluses are administered to patients prior to initiating cardiopulmonary bypass. Many institutions also test for adequate heparinization before going on pump using a target activated clotting time (ACT) > 480 seconds. In such large doses, much of the…
This post was inspired by a discussion I had with Dr. Les Yarmush, one of my cardiothoracic anesthesia attendings. I’ve become accustomed to titrating many short acting medications to manage hemodynamics in the ICU and operating room arenas. I like to factor in a patient’s comorbidities and “test” their response…
The onset of intravenous narcotic medications (morphine, fentanyl, remifentanil, alfentanil, sufentanil, etc.) is related to their respective lipid solubilities. For example, fentanyl is roughly 600x more lipid soluble than morphine, and therefore has a much faster onset. However, alfentanil is an exception to the rule… and exams love to torture…
After consenting my patients for general anesthesia, I’m occasionally asked what drugs will be used during surgery. Without going into too much detail, I refer to our agents by general classes: volatiles, narcotics, muscle relaxants, hypnotics, and reversals. The more medically-inclined patients will often ask for specific names too. Here are…
Earlier this year, the FDA nixed two drugs I was really looking forward to using in my training and/or practice.
With nearly six months of anesthesia under my belt, I have a newfound respect for many of the drugs we administer intraoperatively… especially the potential dangers of insulin and protamine.
Let’s start with a Wikipedia reference of medical abbreviations. A lot of these terms deal with the frequency of taking medications. Now, let’s analyze some common pairs: BID (twice a day) versus q12h (every 12 hours); TID (thrice a day) vs q8h (every 8 hours). There is certainly a difference!
“Induction” refers to the first major step in general anesthesia where agents are used to confer sedation and ultimately loss of consciousness. For the most part, induction agents modulate the GABA receptor, the chief inhibitory neurotransmitter of the central nervous system (CNS), altering chloride ion conductance and leading to the hyperpolarization…