Anesthesiology and Intensive Care

" Heparin and protamine combine in proportion to weight. One milligram of protamine neutralizes 1 mg (typically 100 U) of heparin. Protamine administration:  Always administer protamine slowly. The rate of administration is more important than the route of administration in preventing adverse hemodynamic effects.  One can either use a syringe or dilute the drug in a small volume of intravenous fluid and infuse by gravity  or calibrated pump. Because the syringe technique rather than hand-operated syringe administration, because this reduces the  natural tendency to administer the protamine too quickly and it frees our hands for other  important patient care activities (e.g., vasoactive drug titration, echocardiography examina tion) that coincide with protamine administration. The injected dose of protamine cannot neutralize heparin bound to plasma proteins or  within endothelial cells. Release of heparin from these stored areas after initial prot

Reversal of Neuromuscular Blockade .  One new RCT corroborates findings reported in the original ASA Guidelines regarding the efficacy of edrophonium to antagonize the effects of neuromuscular blocking agents ( e.g. , rocuronium, cisatracurium, rapacuronium) when compared with spontaneous recovery ( Category A3-B evidence ).The original Guidelines indicated that neostigmine is effective for the antagonism of residual neuromuscular blockade ( Category A1-B evidence ); new literature is insufficient to further evaluate these findings. The original Guidelines reported an increased frequency of postoperative emetic episodes with the use of neostigmine ( Category A1-H evidence ); new literature is insufficient to further evaluate this finding. The literature continues to be insufficient to evaluate the occurrence of other complications associated with either edrophonium or neostigmine. The consultants and ASA members are equivocal regarding whether anesthetic regimens design

Preoperative management of asthma In patients with reversible airway obstruction and bronchial reactivity, preoperative treatment w ith β2-adrenergic agonists and corticosteroids should be considered. β2-adrenergic agonists have been shown to attenuate the reflex bronchoconstriction following endotracheal intubation. Even with this intervention, significant bronchoconstriction and wheezing occurs following intubation.