Anesthesiology and Intensive Care

    The  King's College Criteria  or the  King's College Hospital criteria  were devised in 1989 to determine if there were any early indices of poor prognosis in patients with  acute liver failure (ALF) and to identify patients with ALF who would benefit from liver transplantation.

     Laryngospasm is a potentially life-threatening condition that can be managed through expeditious use of sedation, neuromuscular blockers, and airway maneuvers. Patients at high risk for this complication can be identified and measures taken to prepare for this complication.

          Morbidity and mortality associated with herbal use may be more likely in the perioperative period because of the polypharmacy and physiological alterations that occur.    Such complications include bleeding from garlic, ginkgo, and ginseng and potential interaction between ginseng-warfarin.  It is especially important for anesthesiologists to be familiar with related literature on herbal medications when caring for patients in the perioperative period.       Garlic Garlic is one of the most extensively researched medicinal plants. It has the potential to modify the risk of developing atherosclerosis by reducing blood pressure, thrombus formation, and serum lipid and cholesterol levels. The usual dosage is 4 g (∼2 cloves) of fresh bulb or its equivalent as an extract or tincture per day. Garlic inhibits in vivo platelet aggregation in a dose-dependent fashion. The effect of one of its consti...

          Local anesthetic toxicity (LAST)  can occur because of inadvertent intravascular injection or dosing error. Intravascular injection can cause toxicity even if the anesthetic was administered within the recommended dose range.

         Arterial blood pH is normally 7.35–7.45.          Disorder that tends to reduce pH to a less than normal value is an acidosis , whereas one tending to increase pH is termed an alkalosis .     If the disorder primarily affects [HCO3 − ], it is termed metabolic . If the disorder primarily affects PaCO2 , it is termed respiratory .

    Patients with hypotension and shock without other cause are considered to have massive Pulmonary Embolism (PE) .     When obstruction occurs by embolism, the RV experiences an acute rise in pressure and volume, causing shift of the interventricular septum toward the left ventricle. In addition, as RV output  decreases,

    The Rapid Sequence Induction is a technique of inducing general anesthesia so as to reduce the risk of pulmonary aspiration of gastric contents.

          The general recommendation to use aspirin in children was withdrawn because of Reye syndrome, with use of aspirin only recommended in  Kawasaki disease .    Reye syndrome is a rapidly progressive encephalopathy.  

                       --  Back to reading recommendations  1 -16  -- Recommendation 17:  Oral administration of paracetamol is preferable to rectal administration in children, because absorption is more constant and it is possible to achieve a more precise dosage based on body weight (evidence level I; strength of recommendation A). 

Recommendation 1 : Rectal measurement should not be used routinely in children aged < 5 years because it is invasive and causes discomfort (evidence level III; strength of recommendation D). 

         Maternal hypocapnia , conversely, may be associated with fetal hypoxia and acidosis .

    A guide to which regular medications should be continued until the day of surgery. Continue: Statins (decreases in-hospital mortality and need for RRT) β-Blockers (reduced risk of post-CABG AF) Nitrates Calcium antagonists K+ channel openers Corticosteroids Anti-dysrhythmics Bronchodilators

    Any procedure where the operative site is higher than the right atrium and where the vasculature is exposed in a surgical field carries a risk of air embolism. The addition of a pressure gradient between the surgical site and the right heart substantially increases the risk. A pressure difference as small as 5 cm of water will allow 100 ml of air entrainment per second via a 14-gauge cannula. This is the rational for head down position during central venous cannulation. Hypovolaemia and negative pressure associated with spontaneous respiration will also increase the pressure difference and hence the risk.    Additional risks include interventions accessing the circulation such as central venous cann itional risks include intervention ulation (causing air embolism) or using carbon dioxide insufflation during laparoscopic surgery (causing CO2 embolism). Air may also be inadvertently injected via a vascular access device. The risk factors for air embolism...

Phases of the Starvation Response:

         The reversal agent used for warfarin is a synthetic preparation of  phytomenadione (vitamin K1). The presence of vitamin K is essential  for formation of prothrombin, factor 7, factor 9 and factor 10.

    Dopamine, norepinephrine, and epinephrine are physiologically active molecules known as catecholamines. Catecholamines act both as neurotransmitters and hormones vital to the maintenance of homeostasis through the autonomic nervous system. Physiologic principles of catecholamines have numerous applications within pharmacology.      Different medications have different r elative receptor activity. See Table:

    Even mild hypokalemia  (serum K+ = 3 mEq/L) is associated with a considerable K+ deficit (175 mEq)! Estimated deficits are for a 70 kg adult with a total body Potassium 50 mEq/kg. Read also:  IV fluid prescription (by body weight) for routine maintenance over a 24‑hour period Magnesium & Cardiovascular Diseases