Anesthesiology and Intensive Care

Milrinone, an analogue of amrinone, is a bipyridine derivative with inotropic activity that is almost 20 times more potent than that of amrinone and a shorter half-life. Milrinone is an effective inodilator for patients with decompensated HF and low CO after cardiac surgical procedures. 

Malignant Hyperthermia Malignant hyperthermia (MH) is a rare (incidence of 1 in 50,000–70,000 in the UK), autosomal dominant condition, affecting males (62%) more than females (38%) and may occur after many previous anaesthetics.

Loop Diuretics Furosemide, Bumetanide  Loop diuretics (carboxylic acid derivatives) are used in severe heart failure to reduce peripheral and pulmonary oedema . They are also used in chronic and acute renal failure.

Noradrenaline, Mechanism of Action, Effects Presentation and Uses Noradrenaline is presented as a clear solution containing 0.2–2 mg.ml−1 noradrenaline acid tartrate, which is equivalent to 0.1–1 mg.ml−1 of noradrenaline base, and contains the preservative sodium metabisulfite. It is used as an intravenous infusion (dose range 0.05–0.5 μg.kg−1.min−1) to increase the systemic vascular resistance.

DE-AIRING THE HEART AFTER CARDIAC SURGERY   After completing the repair and as the cardiac chambers are closed or as CABG is being completed, the heart must be freed of as much air as possible before it begins to eject into the systemic circulation. Clinical studies have demonstrated a correlation between the number of gaseous microemboli and the severity of neuropsychological impairment after surgical procedures employing CPB. Thus, special maneuvers are necessary to avoid air embolism, as has clearly been demonstrated by intraoperative echocardiography.  The exact steps and sequences and the time of de-airing may vary, but the principles are well established: 

Intraoperative Insulin Management Protocol (Cleveland Clinic) Starting insulin:  0.1 mmol/L = 1.80 mg/dL Start if pre-CPB blood glucose > 120 mg · dL−1 (6.6mmol/l) and if on-pump or post-pump blood glucose > 150 mg · dL−1. (8.33mmol/l). Bolus dose: 

Anatomical Sites of Action General anaesthetic agents affect both brain and spinal cord to account for physiological responses to nociception, loss of consciousness and inhibition of explicit memory. Auditory and sensory evoked potential data implicate the thalamus as the most likely primary target, but secondary sites such as the limbic system (associated with memory) and certain cortical areas are also

Blood–Brain Barrier, drug transportation: The blood–brain barrier (BBB) is an anatomical and functional barrier between the circulation and the central nervous system. Active transport and facilitated diffusion are the predominant methods of molecular transfer, which in health is tightly controlled.