Anesthesia for pregnant patients

No zofran, no midazolam 

Narcotics ok

Adductor Canal Block

Sartorius muscle 

Mid thigh

Nerve lateral to artery

Larval to medial

AICD

Most AICD are turned off by cardiologist

If fired accidentally call cardiologist in pacu to interrogate.

Fresh Gas Low in Drager

Empty water trap

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

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. 

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.

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

Oral Narcotics

Percocet - oxycodone + acetaminophen 

(5/325)

Norco - hydrocodone + acetaminophen (5/325), (7.5/325), (10/325)

Vicodin - hydrocodone + acetaminophen 

Vicodin (5/500)

Vicodin ES (7.5/750)

Vicodin HP (10/660)

Midazolam for Amnesia

http://www.ncbi.nlm.nih.gov/m/pubmed/10464905/

Study done with bronchoscopy showed that 10mg of midazolam in average is required to achieve amnesia. 

Cardiac Ablation

The patient should continue anticoagulant if already on.

GETA

Muscle relaxant to control respiration. I:E ratio 1:4

Pediatric temperature probe

Heparinization.

VP Shunt

Anesthesia for VP Shunt

Type and cross 2 unit of blood although blood loss is usually minimal.

Transfusion

Recipient     RBC Doner     FFP Doner

AB               AB,A,B,O        AB

A                 A,O                 A, AB

B                 B,O                 B, AB

O                 O                   O, A, B, AB

Rh+             Rh- or Rh+     Rh+ or Rh-

Rh-              Rh-                 Rh+ or Rh-

Introp Fluid Management

Introp Fluid Management

Cerebral Aneurysm

Nitroprusside 0.3-10  mcg/kg/min. Usual range 3-4 mcg/kg/min.

Esmolol 50-200 mcg/kg/min

Nitroglycerin 5-400 mcg/min

Protonix IV

40mg reconstituted in 10cc NS ivp over 2-3 minutes

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

D & C

Oxytocin 20 units not to run too quickly to avoid hypertension.

Adrenalnectomy

Potential for blood loss.

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

Endovascular AAA

ETT

A line

Heparin

Hold respiration during contrast injection to visualize the aorta.