Monday, October 19, 2015

Adductor Canal Block

Sartorius muscle 
Mid thigh
Nerve lateral to artery
Larval to medial

Monday, October 12, 2015

AICD

Most AICD are turned off by cardiologist
If fired accidentally call cardiologist in pacu to interrogate.

Wednesday, September 30, 2015

Fresh Gas Low in Drager

Empty water trap
High peep and pip can sometimes be from water in the circuit

Friday, September 11, 2015

Abdominal Liposarcoma Excision

Large tumors have potential for extensive blood loss. There will also be extensive third spacing and loss of protein and albumin. Transfusion with combination of PRBC, FFP, Albumin will be necessary. 

Thursday, September 3, 2015

Drug dosage

Propofol induction 2mg/kg
Rocuronium 1mg/kg
Succinylcholine 1mg/kg
Vecuronium 0.1mg/kg
Phenylephrine initial dose 100-180 mcg/min maintenance 40-60 mcg/min.

Sunday, August 30, 2015

OB Anesthesia

Beginning of the day

Bring donuts, I phone with music
Pick up the phone and key
Take sign out, familiarize with all the patients
Assign all patients with epidurals to you
Check with nurse regarding patient's anesthesia preference
Check OR - make sure to have ETT 6,7 LMAs, LMA supreme

Labor Epidural
Bring tagerderm and tape, Bupivicaine 0.25%
Bicitra and fluid bolus before epidural 
Average epidural space is 5 cm in
Leave 5 cm of catheter in the epidural space
Aspirate before injecting local anesthetic 
Place patient in LUD after epidural injection. Patient will have to switch sides to achieve bilateral block.

Test dose 3cc 1.5% Lidocaine with 1:200,000 epi

Bolus dose - 

< 3cm - 0.125% Bupivicaine. 10cc. Severe pain 15cc.

> 3cm - 0.125% Bupivicaine. 15cc in 2 doses. Severe pain 0.25% Bupivicaine 

> 8cm - 0.25% Bupivicaine 10cc in 2 doses. + Fentanyl 50 mch prn.

Continuous infusion 12-15cc/hour, bolus 12, lock out 12 minutes

For perineal pain Lidocaine 1.5% 12-15cc with patient sitting

Top up
10cc 0.125% Bupivicaine 
10cc 0.25% Bupivicaine 

C-Section

Bacitra and ranitidine 
Bupivicaine 0.75% with dextrose 1.6 cc  + 0.2 mg Morphine (Fentanyl 15-35mcg optional. Last 45 mins)
Left uterine tilt
Phenylephrine, ephedrine, bolus fluid for hypotension
T4 level

Epidural for C-section
Lidocaine 2% + epi + bicarbonate 1mEq per 10cc of Lidocaine 20-30cc
Fentanyl 50mcg
Morphine 4mg after delivery 
Chloroprocaine 15-20cc for STAT section

Pitosin 20 units in first bag of IV fluid and 20 units in the second bag.
If surgeon ask for IV can give 5 units IV if VSS amenable.

GA for C-Section 

Propofol 2-2.5mg/kg, Succinylcholine 1.5mg/kg
Rocuronium 10-20mg
If on magnesium no muscle relaxant is necessary
O2/N2O 50/50 + 1 MAC Sevo
After delivery 70% N2O + 0.5 MAC Sevo , Midazolam 2mg, Fentanyl 200-300mcg
Fully awake and reversed before extubation

Epidural cart code 6789