Intravenous Fluids
Intravenous Fluids ▪Fluid Maintenance Maintenance rate Maintenance requirements: (4-2-1 Rule) 1-10 kg = 4 cc/kg/hr 40 cc (110 cc for a 70 kg pt) 11-20 kg = 2 cc/kg/hr 20…
ANESTHESIA
FOR OBSTETRIC AND GYNECOLOGIC SURGERY
ANESTHESIA FOR LABOR AND DELIVERY • Nonpharmacologic analgesia choices: Hypnotherapy, hydrotherapy, and transcutaneous electrical nerve stimulation (TENS) • Pharmacologic analgesia: Inhalation analgesia, parenteral opioid analgesia (fentanyl, nalbuphine), pudendal block, paracervical…
ELECTROLYTES, & TRANSFUSION THERAPY
(LR, NS, & hetastarch → shown to ↑ neutrophil activation; blood, 7.5% hypertonic saline, & albumin did not have this effect) Figure 9-1. Assessment of volume status. Colloid osmotic pressure (COP)…
ANESTHESIA
• Infant chest wall deforms easily → because of cartilaginous structure • Accessory muscles provide limited support (poor anatomic rib configuration) • Infantile diaphragm contains 20–25% of fatigue-resistant type I…
MANAGEMENT AND DISCHARGE
Initial Diagnosis & Management 1. Examine & stabilize—check Airway, Breathing & Circulation 2. Fluid resuscitate—obtain adequate venous access 3. Review data—patient history, anesthesia record, surgical procedure, estimated blood loss, PACU…
MONITORING
Figure 7-1. The hemoglobin-oxygen (Hb-O2) dissociation curve. NONINVASIVE BLOOD PRESSURE MONITORING (OSCILLOMETRIC SPHYGMOMANOMETRY) Basis: Air cuff inflated around extremity, transducer reads oscillations from systolic pulsation • Inflation pressure raised above systolic…
ANESTHESIA
Sacral cornu (S5) • Thoracic spinous processes—angled caudally (in relation to vertebral bodies) • Lumbar spinous processes—angled horizontally • “S-shape of spinal column”: Thoracic kyphosis (convex) at T4; lumbar lordosis…
PAIN MANAGEMENT
Acute pain: 0 to 4–6 wks Subacute pain: 1 to 3 mos Chronic pain: Persistent pain >3 mos without biologic value Figure 29-1. Algorithm for pharmacologic management of chronic pain. LOW…
FOR ENDOCRINE SURGERY
Hyperthyroidism Anesthesia for Hyperthyroidism • Preop • General: Euthyroid status preferred (risk of thyroid storm), check TFTs, continue antithyroid meds & β-blockers to the day of surgery • Airway: Check…
