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206 ● AnesthesiA student survivAl Guide Table 14.4 Example fluid replacement calculation. Patient and procedure: An 80 kg male patient undergoes a 1-h tonsillectomy at 8:00 am after being made nPO at midnight. Blood Loss: estimated blood loss is ultimately 250 ml Crystalloid vs. colloid choice: Crystalloid is adequate, no colloid needed for this small volume blood loss. lactated ringers is optimal though saline could be used. Replacement: (Calculated from the four parts of table 14.3.) total crystalloid administered is: 120 ml (maintenance for the 1 h duration) +960 ml (for the nPO deficit) +750 ml (for the blood loss) ±250 ml (for the third space loss, estimated at 2 ml/kg/h) =2080 of ns or lr over the 2 h perioperative period. Postoperative maintenance: May be 120 ml per hour with adjustments made based on vital signs and urine output. Colloids may even under some circumstances draw interstitial fluid back into the intravascular space. Albumin 5% is the colloid most commonly used as a volume replacement. If diluted from 25% albumin it must be diluted with NS, not with hypotonic solutions like water or ½ NS. Improperly diluted albumin can cause fatal hemolysis after infusion into a patient. Plasmanate® (purified protein fraction 5%), contains mostly albumin (88%) but also alpha- and beta- (12%) and some gamma-globulins (1%). Plasmanate is heat-treated to be nonreactive immunologically. But, Plasmanate®, like albumin, is considered to be a “blood product” and therefore unacceptable to many individuals on religious or other grounds. It has 145 meq/l NaCl and is isotonic to plasma. Hetastarch® (ethoxylated amylopectin 6%), is a solution of derivatized macromolecular complex carbohydrates. It has the same tonic, osmotic, and oncotic properties as the protein solutions, but is derived from vegetable matter, and therefore is not a “blood product” and is acceptable to many otherwise opposed to receiving derivatized plasma, such as Jehovah’s Witnesses. Hetastarch® and other similar products are also much less expensive than protein derivative solutions.
Table 14.5 Ingredients and characteristics of commonly used crystalloid and colloid fluids. LR D5LR Normosol-R ® Plasmalyte-148 ® Hetastarch Albumin 5% Plasmanate 5% eleCtrOlYtes, Fluids, ACid-BAse AnAlYsis, And trAnsFusiOn therAPY ● 207 IV fluid H O D5W NS D5½ NS + 2 KCl 20 meq/l ph 7.0 4.0 5.5 4.5 6.5 4.9 7.4 5.5 5.5 7.4 7.4 Mosm/l 0 252 308 446 279 525 296 294 310 309 280–285 na meq/l 0 0 154 77 130 130 140 140 154
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Anesthesia Student Survival Guide
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Editors Jesse M. Ehrenfeld, MD, MPH
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Foreword As anesthesiologists and H
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Contents Case Studies xvii Section
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ContEntS ● xi 19 Physiology and A
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Contributors Basem Abdelmalak, MD S
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David C. Lai, MD Partner, Allenmore
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CASE STUDIES In order to focus your
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CASE StUDIES ● xix inhalation ane
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CASE StUDIES ● xxi around the job
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CASE StUDIES ● xxiii ● Although
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CASE StUDIES ● xxv ● You plan a
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CASE StUDIES ● xxvii ● What oth
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CASE StUDIES ● xxix Chapter 23 Ca
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CASE StUDIES ● xxxi of her left h
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CASE StUDIES ● xxxiii speechless.
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CASE StUDIES ● xxxv things go ver
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How to Be a “Star” Student, Car
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hOw tO Be A “stAr” student, CAr
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Pre-Op Holding Area Preoperative Ev
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History of Anesthesia and Introduct
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history of AnesthesiA And introduct
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Pharmacology Section II
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30 ● AnesthesiA student survivAl
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The Preoperative Patient Evaluation
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THe PreoPerATIve PATIenT evAluATIon
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Therapy-based indications radiation
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Table 8.5 Formulation an anesthetic
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Anesthesia Equipment and Monitors B
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AnesthesiA eQuiPment And mOnitOrs
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● ● ● AnesthesiA eQuiPment An
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Table 11.3 Data typically obtained
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Page 182 and 183: AnesthesiA eQuiPment And mOnitOrs
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Page 186 and 187: Anesthetic Techniques: General, Sed
Page 188 and 189: Anesthetic techniques: GenerAl, sed
Page 190 and 191: Table 12.2 Stages of general anesth
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Page 200 and 201: Anesthetic Techniques: Regional Ant
Page 202 and 203: Figure 13.2 Surface anatomy for neu
Page 204 and 205: Table 13.1 Risks of neuraxial anest
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Page 234 and 235: Table 14.6 Advantages, disadvantage
Page 246 and 247: Table 14.11 Transfusion of bloodpro
Page 254 and 255: Chapter 15 IV, Gastric Tube, Arteri
Page 256 and 257: iv, GAstric tube, ArteriAl & centrA
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Page 270 and 271: Pneumothorax Uncommon, but may spon
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Table 16.3 (continued) Problem Diff
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COMMON INTRAOPERATIVE PROBLEMS ●
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COMMON INTRAOPERATIVE PROBLEMS ●
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Systems Physiology and Anesthetic S
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Chapter 20 Physiology and Anesthesi
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PhysioloGy And AnesthesiA for Gener
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Anesthesia for Urological Surgery P
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AnesthesiA for uroloGicAl surGery
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Physiology and Anesthesia for Pedia
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PhysioloGy And AnesthesiA for PediA
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Table 22.6 Common pediatric emergen
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Physiology and Anesthesia for Elder
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PhysioloGy And AnesthesiA for elder
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Chapter 24 Ambulatory Surgery and O
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AmbulAtOry Surgery ANd Out-Of-Or (O
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Perioperative Acute and Chronic Pai
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PerioPerAtive ACute And ChroniC PAi
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Chapter 27 Postoperative Anesthesia
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POstOPerAtive AnesthesiA CAre unit
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Introduction to Critical Care Bever
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introduction to criticAl cAre ● 4
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SVR = [(MAP - CVP)/CO] ´ 80 introd
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● ● ● ● ● introduction to
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Chapter 29 Professionalism, Safety,
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ProfessionAlism, sAfety, And teAmwo
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Chapter 30 Quality Assurance, Patie
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QuAlity AssurAnce, PAtient And Prov
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Chapter 32 Clinical Simulation in A
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Table 32.1 Matrix of categories of
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CliniCAl simulAtion in AnesthesiA e
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ASA Difficult Airway Algorithm Appe
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518 ● ANESTHESIA STUDENT SURVIVAL
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