50% dextrose solution (D50W) typically comes as a 50 cc pre-filled syringe containing 25 grams of dextrose. As a cardiac anesthesiologist and intensivist, I most commonly administer D50W to treat profound hypoglycemia or in conjunction with insulin to induce an intracellular shift of potassium in patients with hyperkalemia. Fortunately, these…
Every day as an anesthesiologist, I reconstitute, draw up, and administer antibiotics, hypnotics, narcotics, paralytics, inotropes/pressors, blood products, fluids, vasodilators, and a myriad of other medications. Each year, the FDA receives over 100,000 reports associated with a suspected medication error causing hospitalization, life-threatening emergency, morbidity, and even death!
Intralipid (20% fat emulsion) is a formulation of intravenous fat primarily of soybean oil, glycerin, and egg yolk-derived phospholipids. As an intensivist, Intralipid provides supplementary nutrition to patients on parenteral nutrition; however, as an anesthesiologist, Intralipid is the “rescue” for local anesthetic systemic toxicity (LAST). Although I’ve never seen this…
As an intensivist and anesthesiologist, I spend considerable time pondering the physiology and evidence for practices and questioning dogma rampant in the ICU/OR settings. I’ve heard one recurrent theme: the fear of using Lactated Ringers (LR) and Normosol in patients with renal impairment. Why? Because they both contain potassium (K+),…
Dantrolene (RYANODEX) is an intravenous nanosuspension of dantrolene sodium used as a prophylactic and therapeutic agent to treat malignant hyperthermia (MH) – a life-threatening condition triggered by succinylcholine and halogenated volatile anesthetic gases creating sustained skeletal muscle contraction due to a defect in the release/reuptake of calcium. Dantrolene works by…
Ceftriaxone (Rocephin) is an intravenous/intramuscular third generation cephalosporin that provides decent aerobic gram positive coverage (ie, pneumococcus although bacterial resistance is growing) but wonderful gram negative coverage against organisms like E. coli, Klebsiella, H. flu, and Proteus. Anaerobic bacteria and Pseudomonas are NOT covered by ceftriaxone.
Levetiracetam (Keppra) is an oral and intravenous antiepileptic drug (AED) indicated as adjunctive therapy for partial onset seizures, myoclonic seizures, and generalized tonic-clonic (“grand mal”) seizures in adults. The medication is used in the pediatric population as well for various reasons beyond my scope of practice. Most AEDs either enhance…
Vecuronium (Norcuron) is a nondepolarizing, aminosteroid neuromuscular junction blocker that, like rocuronium, works at the level of neuromuscular end plate’s nicotinic acetylcholine receptors (AChR) as a competitive antagonist. Because it competes with acetylcholine for a similar binding site, vecuronium’s effects can be overcome to increasing the amount of “normal” substrate…
Meropenem (Merrem) is a broad spectrum intravenous antibiotic and member of the carbapenem β-lactam drug class. These antibiotics are often reserved for multidrug resistant organisms (MDR) causing a wide variety of serious infections like hospital acquired pneumonia, intraabdominal infections, neutropenic fever, complicated soft tissue infections, and gram negative sepsis.
