Anesthesiology and Intensive Care

         Type A lactic acidosis is by far the commonest group and is usually due to tissue hypoxia caused by systemic or local hypoperfusion, increased glycolysis, reduced oxygen carrying capacity of the blood or reduced tissue oxygen delivery . Apart from excessive muscle activity, other causes of type A lactic acidosis are rare. The inadequate oxygen supply slows mitochondrial metabolism and leads to increased production of lactate from pyruvate. As a byproduct, NAD +  is regenerated so that glycolysis can continue. If hypoxaemia is the only factor, it must be severe to overwhelm the compensatory increase in tissue blood flow triggered by low PO 2 .

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    Preoperative: Anemia: consider iron, folate, erythropoietin; Anticoagulation: Early withdrawal of antiplatelet agents and warfarin. Switch to unfractionated heparin if necessary;

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Proper positioning avoids injuries and facilitates surgical exposure:

      The cephalosporin antibiotics are the largest and most diverse group of beta-lactam antibiotics. There are five classes of cephalosporins and some other antibiotics  which have not been assigned to a particular generation. click to enlarge or download

Dose of opioid and anesthetic requirements may vary according to pain stimulation: Stay tuned! Sign up with Facebook!

ACC/AHA  Recommendations for Antithrombotic Therapy in Patients With Mechanical Heart Valves:

      The spinal cord terminates on average at the disc between the 1st and 2nd lumbar vertebral bodies (in the adult) . However, there is considerable variation in this level. Frequently, the cord ends opposite the body of L1 or L2, or, rarely, T12 or even L3.

Related to preexisting disease Chronic hypertension, increased intracranial pressure, autonomic hyperreflexia, aortic dissection, early acute myocardial infarction.

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         Opioids may be given intrathecally as a single injection or intermittently via an epidural or intrathecal  catheter. High doses may be associated with a high risk of side eff ects,  most importantly respiratory depression. For that  reason combinations of local anesthetics and opioids  are most commonly used. 

             The harmful effects of aggressive fluid resuscitation on the outcome of sepsis are supported by experimental studies and data accumulated from clinical trials.   Multiple clinical studies have demonstrated an independent association between an increasingly positive fluid balance and increased mortality in patient with sepsis.  The most compelling data that fluid loading in sepsis is harmful, comes from the landmark ‘ Fluid Expansion as Supportive Therapy  (FEAST)’ study performed in 3141 sub-Saharan children with severe sepsis.  In this randomized study, aggressive fluid loading was associated with a significantly increased risk of death. After the Rivers' Early Goal Directed Therapy trial,  which formed the basis for the concept of early aggressive fluid resuscitation, a number of EGDT studies have been published. 

Classification of inotropes by mechanism of action:

According to " Intravenous fluid therapy in adults in hospital" by NICE

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  Indicators that a patient may need urgent fluid resuscitation include:

     A standardised track-and-trigger system for acute illness in people presenting to, or within hospitals. The remit also included the need for recommendations on the urgency of the clinical response required, the clinical competency of the clinical responders and the most appropriate environment for ongoing clinical care, according to the NEWS.