Wednesday, June 24, 2015
Sunday, June 21, 2015
AV Fistual
Usually can be done under MAC.
Heparinization
Reverse with Protamine. (0.25mg - 1mg) of Protamine per 100 unit of heparin depending how long ago the heparin was given. Max dose 50mg.
Do not exceed rate of 5mg/minute
Heparinization
Reverse with Protamine. (0.25mg - 1mg) of Protamine per 100 unit of heparin depending how long ago the heparin was given. Max dose 50mg.
Do not exceed rate of 5mg/minute
Adrenalnectomy
Potential for blood loss.
Lateral position.
Steroid replacement hydrocortisone 100mg.
Lateral position.
Steroid replacement hydrocortisone 100mg.
Craniotomy
Type and cross 2 units of blood.
Use normal saline for fluid.
Do not volume over load the patient. However the patient does have increase urine due to mannitol, and occasionally lasix is given. Therefore the I & O should be balanced.
Check with surgeon regarding
Decadron
Mannitol 0.5-2g/kg - usually come in 25g bottles
Keppra - 1 vial 500mg TRO 15 minutes
Some surgeon use Optisome with ultrasound to help visualize the tumor.
Propofol 100mg can be given before head pinning.
References:
Perioperative Management of Complex Skull Base Surgery: the Anesthesiologist's Point of View
Use normal saline for fluid.
Do not volume over load the patient. However the patient does have increase urine due to mannitol, and occasionally lasix is given. Therefore the I & O should be balanced.
Check with surgeon regarding
Decadron
Mannitol 0.5-2g/kg - usually come in 25g bottles
Keppra - 1 vial 500mg TRO 15 minutes
Some surgeon use Optisome with ultrasound to help visualize the tumor.
Propofol 100mg can be given before head pinning.
References:
Perioperative Management of Complex Skull Base Surgery: the Anesthesiologist's Point of View
Tuesday, June 16, 2015
Endovascular AAA
ETT
A line
Heparin
Hold respiration during contrast injection to visualize the aorta.
Sunday, June 7, 2015
Thoracoscopic Lobectomy
A line
Type and Cross 2 units prbc
Left sided double lumen tube
35
37
39
41
Fluid restriction < 1 liter
Left sided double lumen tube
35
37
39
41
Fluid restriction < 1 liter
Male 39F if > 170cm then 41F
Female 37F if < 160cm then 35F
170cm patient insert tube to 29cm. For every 10cm in height insert tube 1cm deeper, for every 10cm shorter in height insert 1cm less.
Insert double lumen tube, twist left.
Inflate tracheal cuff.
Check end tidal CO2.
Make sure have clamp
Drop lung as soon as in later decubitus position.
170cm patient insert tube to 29cm. For every 10cm in height insert tube 1cm deeper, for every 10cm shorter in height insert 1cm less.
Insert double lumen tube, twist left.
Inflate tracheal cuff.
Check end tidal CO2.
Make sure have clamp
Drop lung as soon as in later decubitus position.
Saturday, June 6, 2015
Glidescope Intubation
1 - Mid-line Insertion
2- Insert styleted tube under direct vision - invert the curve if necessary. First from the side then turn along the curvature of the scope.
3 - Guide the tube under video. Cricoid pressure instead of lifting otherwise the larynx becomes more anterior.
4 - Insert the tube as the stylet comes out.
Cepacol Lozenges for sore throat
2- Insert styleted tube under direct vision - invert the curve if necessary. First from the side then turn along the curvature of the scope.
3 - Guide the tube under video. Cricoid pressure instead of lifting otherwise the larynx becomes more anterior.
4 - Insert the tube as the stylet comes out.
Cepacol Lozenges for sore throat
Wednesday, June 3, 2015
Management of DM medication and Insulin
Hold all oral hypoglycemic agents the day of surgery.
Only Thiazolidiediones (Actos, Avandia) and DPP-IV (Januvia, Onglyza) can be given the morning of the surgery.
Patient on insulin - half of morning intermediate or long acting insulin. May need glucose infusion.
Only Thiazolidiediones (Actos, Avandia) and DPP-IV (Januvia, Onglyza) can be given the morning of the surgery.
Patient on insulin - half of morning intermediate or long acting insulin. May need glucose infusion.
Tuesday, June 2, 2015
Spinal Anesthesia for Total Joints
Bupivicaine 0.75% 1.6cc = 12mg
Duramorph 0.1mg
Bupivicaine 0.5% 2.5cc = 12.5mg
Duramorpha 0.1mg
For longer cases
15mg with epi wash or 0.2mg epi
Duramorph 0.1mg
Bupivicaine 0.5% 2.5cc = 12.5mg
Duramorpha 0.1mg
For longer cases
15mg with epi wash or 0.2mg epi
Should last 2.5 hours
Use Isobariac for hip
If only hyperbaric bupivicaine available
For knee - tilt table 15 degrees to operative side
For hip - position patient operative side down for 3 minutes, then while supine for foley tilt table to operative side.
Tranexamic acid contraindicated in patients with PTCA and stent
Nubain 5-10mg Q4 for pruritis
Use Isobariac for hip
If only hyperbaric bupivicaine available
For knee - tilt table 15 degrees to operative side
For hip - position patient operative side down for 3 minutes, then while supine for foley tilt table to operative side.
Tranexamic acid contraindicated in patients with PTCA and stent
Nubain 5-10mg Q4 for pruritis
Horacek - no duramorph, tranexams acid 1gm in 50cc ivpb
Metta prefer GA and Vancomycin and toradol
Gerhart - spinal without duramorph. Tranexamic acid x 2, toradol
Banffy- spinal + ga. Ask for muscle relaxation. +/- femoral nerve block. No duramorph.
Kevin Ehrhart - Spinal no duramorph, 2 doses of Tranexamic Acid
Moreland- Spinal with 100mcg Duramorph
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