Anesthesiology and Intensive Care

  Noncardiovascular   Disorders, special Features:

Cardiovascular Disorders, special Features:

  Dead space is the volume of inspired air that takes no part in gas exchange. Divided into 2 parts: ◗ anatomical dead space : mouth, nose, pharynx and large airways not lined with respiratory epithelium.  ◗ alveolar dead space :  unperfused alveoli . V entilated lung normally contributing to gas exchange, but not doing so because of impaired perfusion. Thus represents one extreme of V̇/Q̇ mismatch .

 

 Cytotoxic drugs used in the treatment of malignancy and as immunosuppressive drugs. All may cause nausea and vomiting and bone marrow suppression; most are teratogenic and require careful preparation by trained personnel. Extravasation of iv drugs may cause severe tissue necrosis. Some have side effects of particular anaesthetic/ICU relevance:

Subclavian steal syndrome is rare, but sometimes difficult to diagnose. An arteriosclerotic stenotic plaque at the origin of the subclavian (proximal to the takeoff of the vertebral) allows enough blood supply to reach the arm for normal activity, but does not allow enough to meet higher demands when the arm is exercised. 

  The goals for successful management of asthma   include the following   : Achieve and maintain control of asthma symptoms Maintain normal activity levels, including exercise Maintain pulmonary function as close to normal as possible Prevent asthma exacerbations Avoid adverse effects from asthma medications Prevent asthma mortality Asthma symptoms and severity:

  It was a mystery even Albert Einstein couldn’t solve.  For years, the brilliant physicist was plagued with abdominal pain.  At times it was so severe it would cause him to vomit.  Finally, in the fall of 1948, he sought the advice of Dr. Rudolph Nissen, a thoracic surgeon at Brooklyn Jewish Hospital. 

  Thalassemia is a hereditary underproduction of either the alpha or beta globin chains of the  hemoglobin molecule, resulting in a hypochromic, microcytic anemia. Gene deletion results  in variable levels of disease. There are 4 genes coding for the alpha chain of hemoglobin.

  Strong Recommendations For patients with PE ( pulmonary embolism ) and hemodynamic compromise, it is recommended that thrombolytic therapy followed by anticoagulation be used over anticoagulation alone. For patients with DVT ( deep vein thrombosis ) and/or PE who have completed primary treatment and will continue vitamin K antagonist (VKA) therapy as secondary prevention, it is recommended that an international normalized ratio (INR) range of 2.0 to 3.0 be used over a lower INR range . For patients with a recurrent unprovoked DVT and/or PE , indefinite antithrombotic therapy is recommended over stopping anticoagulation after completion of primary treatment.

  Creatine kinase (CK) is found in striated muscle and tissues of the brain,  kidney, lung, and GI tract. This marker has low sensitivity and specificity for cardiac damage,  and total CK levels may be elevated in a number of noncardiac conditions, including trauma, seizures, renal insufficiency, hyperthermia, and hyperthyroidism. As a result,  the total CK  marker largely has been replaced by cardiac troponins and CK-MB.

     Dobutamine , a synthetic analog of dopamine, has predominantly β 1-adrenergic effects.       When compared with isoproterenol, inotropy is more affected than chronotropy. It exerts less of a β2 -type effect than isoproterenol does and less of an α 1 -type effect than does norepinephrine. Unlike dopamine, endogenous norepinephrine is not released, and dobutamine does not act at dopaminergic receptors.