Anesthesiology and Intensive Care

Drugs known to cause congenital malformations:

     Transesophageal Echocardiography (TEE) is often  performed by a cardiac anesthesiologist to evaluate, diagnose, and treat patients in the perioperative period. TEE is very useful during many cardiac surgical procedures (e.g., mitral valve repair, off-pump and on-pump CABG).  It helps to detect and quantify the disease preoperatively as well as to assess the results of surgery immediately after the procedure.  If the repair is found to be inadequate,

Amazing Demonstration of Arterial Line Placement INDICATIONS: Continuous direct BP monitoring Inability to use indirect BP monitoring (eg, in patients with severe burns or morbid obesity) Frequent blood sampling Frequent arterial blood gas sampling CONTRAINDICATIONS: Absent pulse Thromboangiitis obliterans (Buerger disease) Full-thickness burns over the cannulation site, infection Inadequate circulation to the extremity Raynaud syndrome Synthetic vascular graft COMPLICATIONS: Temporary radial artery occlusion (19.7%) Hematoma/bleeding (14.4%) Localized catheter site infection (0.72%) - The risk increases with the length of time the catheter is in place  Hemorrhage (0.53%) Sepsis (0.13%) Permanent ischemic damage (0.09%) Pseudoaneurysm formation (0.09%) Thrombosis Arteriovenous fistula Air embolism Compartment syndrome Carpal tunnel syndrome...

INDICATIONS: Major operative procedures involving large fluid shifts and/or blood loss Intravascular volume assessment when urine output is not reliable orunavailable (e.g. renal failure) Major trauma Surgical procedures with a high risk of air embolism, such as sitting position craniotomies. In addition to monitoring, the central venous pressure (CVP) catheter may also be used to aspirate intracardiac air Frequent venous blood sampling Administration of medications that require central access e.g. amiodarone, inotropes, high concentration electrolytes Chronic drug administration Unavailable peripheral IV access Rapid infusion of IV fluids Peripheral blood stem cell collections Special Uses: (i) Insertion of PA catheters; (ii) Insertion of transvenous pacing wires; (iii) Hemodialysis/plasmapheresis. CONTRAINDICATIONS: SVC syndrome Infection at the site of insertion Traumatised site (eg. clavicle fracture and subclavian line) Burned site Coagulopathies Newl...

           INDICATIONS FOR ECMO Non-cardiogenic respiratory failure . Potentially reversible (Pneumothorax / large pleural effusion drained, trial of diuresis).                 IF : Optimal ventilation (including PEEP >10cmH2O)                  Consider PCV or CMV: VT < 8ml /kg (ideal body weight), prone ventilation, recruitment                    manouevre.               BUT : PaO2 / FiO2 < 80mmHg or pH < 7.25 for > 2 hours Cardiogenic shock of any aetiology . Potentially reversible OR candidate for destination therapy. Refractory to maximal medical Rx.   Fulminant myocarditis  requiring inotropes or IABP at any time( left heart failure + aseptic febrile illness < 2 weeks, marked troponin elevation, abnormal ECG and / or arrhythmia) ...

Bowel obstruction: Obstructed bowel is a closed space.  Emphysema: Blebs can accumulate N2O and burst. Air embolism: If suspected, turn off N2O immediately. Eye surgery when intraocular gases are used: Expansion of gas bubble can cause blindness. Middle ear surgery: Accumulation can dislodge a tympanic graft after tympanoplasty. Chest wall or head trauma: N2O can ↑ pneumothorax or ↑ ICP respectively _________________________________________________________________________________ Кишечная непроходимость: ущемленная кишка в закрытом пространстве Эмфизема: буллы могут накапливать N2O и разрываться Воздушная эмболия: при подозрении немедленно остановите подачу N2O  Глазная хирургия при использовании внутриглазных газов: расширение глазного яблока может привести к слепоте Хирургия среднего уха: накопление N2O может оттеснить тимпанический шунт после тимпанопластики Травма грудной стенки или головы: N2O может усугубить пневмоторакс...