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OPENANESTHESIA
COVID-19 Resources. An otherwise healthy 45-year-old woman is seen at an ambulatory surgical center for release of Dupuytren's contracture. A brachial plexus block is performed using the axillary approach. Assuming that no other nerve blocks are performed, and that the axillary block successfully achieves a complete motor and sensoryblock in
PACEMAKERS/AICDS
NMBS: ED95 DEFINITION Definition. According to Miller, potency of a NMBD is best described as the effective dose – “The dose of a neuromuscular blocking drug required to produce an effect (e.g., 50%, 90%, or 95% depression of twitch height, commonly expressed as ED50, ED90, and ED95, respectively“. Thus, the ED95 is the amount of NMBD required toreduce twitch
MAXIMUM ABL CALCULATION Also, what is the allowable blood loss (ABL) of this patient if her Hct is 45? In the example above, EBV = 50kg x 65 (adult woman’s blood volume) = 3250 The initial Hct (Hi) = 45%, her current Hct The final lowest acceptable Hct (Hf) = 30% (What ever cut off is used clinically to decide how low the individual’s Hct will be allowed todrop.
THYROIDECTOMY: COMPLICATIONS Thyroidectomy Complications. Hypocalcemia (3-5%): most common cause of airway obstruction after 24 hours. Hematoma (1-2%): most common cause of airway obstruction within 24 hours. Recurrent laryngeal nerve injury (0.77%): usually causes unilateral damage, stridor, hoarseness. Wound infection (0.2-0.5%) HYPERMAGNESEMIA TREATMENT Hypermagnesemia requires close monitoring of the ECG, blood pressure, and neuromuscular function. Potentiation of the vasodilating and negative inotropic properties of anesthetics should be expected. Dosages of NMBAs should be reduced by 25–50%. A urinary catheter is required when diuretic and saline infusions are used to enhancemagnesium
DELAYED EMERGENCE: DIFFERENTIAL DIAGNOSIS Differential diagnosis of delayed emergence can be classified into one of three causes: drug effects, metabolic disorders, or neurologic disorders.If a patient doesn’t “wake” after an anesthetic you have to go down these three in that particular order. PHASE II DEPOLARIZING BLOCKADE The possibility of a phase II block should be suspected if succinylcholine is given as an infusion or if tachyphylaxis is noted with repeated doses. With regard to nerve stimulation, a phase II block has features of a non-depolarizing block (i.e., fade is seen with tetanic and train-of-four stimulation; there is post-tetanicpotentiation).
MULTIPLE SCLEROSIS: PERIOP MGMT Multiple Sclerosis is an autoimmune disease of inflammation, demyelination, and axonal damage to the central nervous system (Pasternak, 2008; Dorotta, 2002). The disease progression may be subacute with relapses and remissions or chronic and progressive. Treatments include corticosteroids, Interferon-beta, glatiramer acetate, azathioprine, and MANAGEMENT OF BRADYCARDIA IN THE OR Management of Bradycardia in the OR1. Bradycardia can be defined as aheart rate
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