Anesthesiology

Table Of Contents
1 Normal Values for Hemodynamic Parameters
2 Risk Factors for Difficult Intubation
3 Risk Factors for Difficult Mask Ventilation
4 Cardiology
4.1 Cardiac Complications: Predictive Criteria
4.2 IHSS (HOCM)
4.3 SVT: Management
4.4 Tet Spell: Outflow Obstruction of Heart
5 Nerve Blocks for Awake FOI
6 Infectious Disease
6.1 SIRS Criteria
7 Neuro
7.1 Complex regional pain syndrome (CRPS)
8 OBGYN
8.1 Pre-Eclampsia: Systemic Effects
8.2 Pregnancy Induced HTN (PIH)
8.3 Severe PIH
9 Respiratory problems
9.1 Pulmonary Function Test
9.2 Wheezing-Differential Diagnosis
10 Malignant Hyperthermia
11 Hypothermia

Normal Values for Hemodynamic Parameters

Risk Factors for Difficult Intubation

Risk Factors for Difficult Mask Ventilation

Cardiology

Cardiac Complications: Predictive Criteria
  • 1) High-risk surgery (major vascular, abdominal, thoracic, or ortho surgery)
  • 2) H/o ischemic heart disease (risk of re-infarction is high for 2 months after an MI)
  • 3) H/o CHF
  • 4) H/o cerebrovascular disease
  • 5) H/o preoperative use of insulin
  • 6) Pre-op serum creatinine >2.0
  • 7) Active cardiac conditions:
    • -unstable coronary syndromes (unstable angina, MI within last 2 months)
    • -decompensated heart failure
    • -significant arrhythmias
    • -significant valvular disease
IHSS (HOCM)
  • Pathophysiology
    • dynamic outflow obstruction, because the degree of obstruction is variable and is dependent on the loading conditions (ventricular filling and arterial blood pressure) and the contractility state of the left ventricle.
  • Anesthetic goals
    • -myocardial depression, often with volatiles
    • -preload full, afterload increased (e.g. phenylephrine)
    • -rate normal, rhythm sinus
    • -beta-blockers are first-line treatment
SVT: Management
Tet Spell: Outflow Obstruction of Heart

Nerve Blocks for Awake FOI

  • Glossopharyngeal Nerve
    • Provides sensory innervation to the posterior third of the tongue, the vallecula, the anterior surface of the epiglottis (lingual branch), the walls of the pharynx (pharyngeal branch), and the tonsils (tonsillar branch).
  • Block Method:
    • It can be blocked using one of three methods: topical spray application, direct mucosal contact of soaked pledgets, or direct infiltration by injection.

  • Superior Laryngeal Nerve
    • Innervates the base of the tongue, posterior surface of the epiglottis, aryepiglottic fold, and the arytenoids.
  • Block method:
    • Direct infiltration is accomplished at the level of the thyrohyoid membrane inferior to the cornu of the hyoid bone.
    • A reliable block with a definite endpoint is effected by retracting the needle marginally after contacting the greater cornu and injecting 2mL of local anesthetic after negative aspiration.
    • Less invasive blockade can be accomplished by placing anesthetic-soaked cotton pledgets into the pyriform fossae bilaterally.

  • Recurrent Laryngeal Nerve
    • Provides sensory innervation to the trachea and vocal folds.
  • Block method:
    • trans-tracheal

Infectious Disease

SIRS Criteria

Neuro

Complex regional pain syndrome (CRPS)
  • CRPS Diagnostic Criteria:
    • a broad term describing excess and prolonged pain and inflammation that follows an injury to an arm or leg.
    • has acute (recent, short-term) and chronic (lasting greater than six months) forms. 
    • used to be known as reflex sympathetic dystrophy (RSD) and causalgia
    • +Continuing pain that is disproportionate to any inciting event.
    • +At least 1 symptom reported in at least 3 of the following categories:
      • Sensory: Hyperesthesia or allodynia
      • Vasomotor: Temperature asymmetry, skin color changes, skin color asymmetry
      • Sudomotor/edema: Edema, sweating changes, or sweating asymmetry
      • Motor/trophic: Decreased range of motion, motor dysfunction (eg, weakness, tremor, dystonia), or trophic changes (eg, hair, nail, skin)
    • +At least 1 sign at time of evaluation in at least 2 of the following categories:
      • Sensory: Evidence of hyperalgesia (to pinprick), allodynia (to light touch, temperature sensation, deep somatic pressure, or joint movement)
      • Vasomotor: Evidence of temperature asymmetry (>1°C), skin color changes or asymmetry
      • Sudomotor/edema: Evidence of edema, sweating changes, or sweating asymmetry
      • Motor/trophic: Evidence of decreased range of motion, motor dysfunction (eg, weakness, tremor, dystonia), or trophic changes (eg, hair, nail, skin)
    • +No other diagnosis better explains the signs and symptoms

OBGYN

Pre-Eclampsia: Systemic Effects
Pregnancy Induced HTN (PIH)
Severe PIH

Respiratory problems

Pulmonary Function Test
  • Normal Values:
    • FEV1
      • 80-120%
    • FVC
      • 80-120%
  • The test is interpreted as within normal limits if both the VC and the FEV1/VC ratio are in the normal ranges.

  • OBSTRUCTIVE ABNORMALITY
    • The test is interpreted as showing obstructive abnormality when the FEV1/VC ratio is below the normal range. The severity of the abnormality might be graded as follows:

  • Mild:
    • Predicted FEV1 <100% and ≥70%
  • Moderate:
    • Predicted FEV1 <70% and ≥60%
  • Moderately severe:
    • Predicted FEV1 <60% and ≥50%
  • Severe:
    • Predicted FEV1 <50% and ≥34%

  • RESTRICTIVE ABNORMALITY
    • Reduction in the VC without a reduction of the FEV1/VC ratio
Wheezing-Differential Diagnosis

Malignant Hyperthermia

  • Treatment:
    • 1. D/c triggering agents
    • 2. Call for help
    • 3. 100% FiO2; high flow; hyperventilate
    • 4. Dantrolene: 2.5 mg/kg IV every 5 min to max 10 mg/kg or until symptoms subside
    • 5. Collect labs: blood gases, electrolytes, calcium, LFT’s, CK
    • 6. Treat hyperkalemia: hyperventilate, dextrose + insulin
    • 7. Active cooling: ice to groin and axilla, ice lavage of the stomach
    • 8. Maintain >2 ml/kg/hr urine output with fluids, Lasix and mannitol; insert foley

Hypothermia