Anesthesia and Pain Management

• PRIS – Propofol Infusion Syndrome – can be fatal.  Cardiac failure, rhabdomyolysis, and a severe metabolic acidosis.
• Adrenal insufficiency secondary from Etomidate (induction agent) administration may be a cause of hypotension in the post op surgical patient.
• Dexmedetomidine  (Precedex)has  analgesic properties, sedation, stable respiratory rates, predictable cardiovascular responses.
• Ativan should not be discountinued abruptly after long term use in the ICU patient.
• Heterotopic calcification and myopathies are complications of long term chemical paralysis – thus chemical paralysis for ventilated patients are now not as popular.
• Pulse oximetry readings not as accurate in patients with smoke inhalation.
• Colorimetric CO2 indicator – stomach intubation can still change the color, initially.
• CNS and Cardiotoxity related to local anesthetic use – a concern when intercostal nerve blocks used for multiple rib fractures.  Lidocaine info
• Place/Pull epidural catheters, won’t do unless lovenox/heparin sq held for 24 h.
• As doses and duration of Metaclopramide (Reglan – Dopaminergic blocker) increases – neurologic side effects (movement disorders) also increases.
• Oral to IV morphine is 3:1
• Main use for LMA is for short cases in operating room.  There are concerns for vomiting and aspiration.