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AmbulAtOry Surgery ANd Out-Of-Or (OOr) PrOCedureS ● 389 Table 24.6 Anesthetic options for GI endoscopy procedures. Option A: 1. Nasal cannula oxygen 2–4 l 2. midazolam (1–4 mg) IVP 3. glycopyrrolate 0.1–0.3 mg IVP 4. Propofol/ketamine (1 mg/ml) infusion @ 80–150 mcg/kg/min propofol after 0.8–1.4 mg/kg bolus at induction Comment: low likelihood of apnea, limited hemodynamic effects, modest analgesia, and possible ketamine side effects Option B: 1. Nasal cannula oxygen 2–4 l 2. Propofol infusion (120–200 mcg/kg/min) after 1–2 mg/kg induction bolus 3. Consider addition of fentanyl 25–100 mcg for highly stimulating procedures Comment: high doses of propofol as sole agent may induce apnea when bolused, no analgesic properties, sole agent provides clean anesthetic, and rapid emergence Option C: 1. Preoxygenate with 100% O via facemask 2 2. deliver high fiO via mapleson circuit attached to patient with lubricated nasal trumpet 2 3. Propofol/remifentanil (2 mcg/ml) infusion at 60–120 mcg/kg/min propofol after 0.6–1 mg/kg bolus Comment: high likelihood of intermittent apnea, profound analgesia and blunting of reflexes, may be best suited to chronic opioid or benzodiazepine users or patients undergoing painful procedures with high anesthetic requirements, and greater hemodynamic side effects than A or b hemodynamic profile. Ketamine does not suppress respiration but may also be associated with unpleasant psychedelic side effects in a subset of patients. Several possible anesthetic approaches are outlined in Table 24.6, although many others can be conceived. Electrophysiology Lab (EP) The wide variety of procedures performed in the EP lab include pacemaker placement, external cardioversion, internal defibrillator placement and testing, and arrhythmia ablation. By definition, all patients have cardiac disease, and many have severe compromise of cardiac function with low ejection fraction, coronary artery disease, and high propensity toward unstable rhythms. Moreover, the EP lab represents a very foreign environment to the anesthesiologist. There is a large amount of equipment that surrounds the patient and often interferes with immediate access to the airway and intravenous catheterization sites.
390 ● AnesthesiA student survivAl Guide The interventional cardiologist commonly controls infusions of vasoactive substances, heparin, and fluids, and has specific target parameters for blood pressure, heart rate, and rhythm. The majority of EP procedures are performed under sedation or brief (
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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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Anesthetic Techniques: General, Sed
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Anesthetic techniques: GenerAl, sed
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Table 12.2 Stages of general anesth
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Table 12.6 (continued) Anesthetic t
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Anesthetic Techniques: Regional Ant
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Figure 13.2 Surface anatomy for neu
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Table 13.1 Risks of neuraxial anest
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Anesthetic techniques: reGionAl ●
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Table 14.6 Advantages, disadvantage
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Table 14.11 Transfusion of bloodpro
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Chapter 15 IV, Gastric Tube, Arteri
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iv, GAstric tube, ArteriAl & centrA
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Common Intraoperative Problems Fran
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Pneumothorax Uncommon, but may spon
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COMMON INTRAOPERATIVE PROBLEMS ●
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Table 16.3 Common intraoperative dy
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Table 16.3 (continued) Problem Diff
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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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Page 362 and 363: PhysioloGy And AnesthesiA for Gener
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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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