WikiAnesthesia - User contributions [en]

Desmopressin

2022-07-18T18:41:39Z

Huckfinne: Create page

Provide a brief summary of this drug here.

==Uses==
==Contraindications==
===Absolute contraindications===
===Precautions===
==Pharmacology==
===Pharmacodynamics===
====Mechanism of action====
V2 receptor agonist without any V1 activity

====Adverse effects====
===Pharmacokinetics===
==Chemistry and formulation==
==History==
==References==

Dexmedetomidine

2022-07-18T17:50:21Z

Huckfinne: add minor bits for MOA.

{{Infobox drug reference
| trade_names =
| image_file = Dexmedetomidine.svg
| drug_class = Sedative hypnotic
| drug_class_color = sedative_hypnotic
| uses =
| contraindications =
| routes = IV, IM, IN
| dosage =
| dosage_calculation = dexmedetomidine
| mechanism = Alpha-2 agonism
| adverse_effects =
| time_onset =
| duration =
| metabolism =
| halflife_redistribution =
| halflife_elimination =
| clearance =
| protein_binding =
}}

Provide a brief summary of this drug here.

== Uses ==
ICU, intra-operative, and procedural sedation without respiratory depression or amnestic properties. May decrease opioid requirement, more so due to sedating rather than analgesic effects.

==Contraindications==

===Absolute contraindications===

===Precautions===

==Pharmacology==

===Pharmacodynamics===

====Mechanism of action====
Central α-2 agonist with a 1600:1 affinity for α-2 receptors over α-1 receptors.

====Adverse effects====
Risk of hypotension and bradycardia, in a dose-dependent manner. Night terrors and transient behavioral effects in children have been reported when used for pre-anesthetic sedation, due to calming effects without amnestic properties.

===Pharmacokinetics===

==Chemistry and formulation==

==History==

==References==

[[Category:Drug reference]]
[[Category:Sedative hypnotics]]

Craniotomy for trauma

2022-07-18T15:04:05Z

Huckfinne: add reference

{{Infobox surgical procedure
| anesthesia_type = General
| airway = ETT
| lines_access = large bore PIV, arterial line, consider central line if poor peripheral access or long term infusions required, ICP drain/monitor
| monitors = Standard plus arterial line and ICP monitoring
| considerations_preoperative = Full stomach, preop neuro exam
| considerations_intraoperative = bleeding, ICP changes
| considerations_postoperative =
}}

Provide a brief summary of this surgical procedure and its indications here.

== Preoperative management ==

=== Patient evaluation ===
{| class="wikitable"
|+
!System
!Considerations
|-
|Airway
|
|-
|Neurologic
|
|-
|Cardiovascular
|
|-
|Pulmonary
|
|-
|Gastrointestinal
|
|-
|Hematologic
|
|-
|Renal
|
|-
|Endocrine
|
|-
|Other
|
|}

=== Labs and studies ===
Preop: CBC for baseline hemoglobin, CMP for electrolytes including sodium and potassium, INR given possible anticoagulants use

Intraop: Serial hemoglobin. Consider frequent Na checks if utilizing hypertonic saline, K checks if hyperventilating. TEG/coagulation studies as needed for resuscitation

=== Operating room setup ===
General anesthesia setup including fluid warmer/blood tubing, arterial line monitoring/setup, multiple infusion pumps, and consider ICP monitoring/drain as guided by neurosurgery.

=== Patient preparation and premedication ===

=== Regional and neuraxial techniques ===

== Intraoperative management ==

=== Monitoring and access ===
Needs arterial line

Consider ICP monitoring as guided by neurosurgery

=== Induction and airway management ===
Avoid increased ICP during induction

=== Positioning ===

=== Maintenance and surgical considerations ===
ICP monitoring and possible reduction including:

* ICP draining
* Hyperventilation
* Steroids
* Antileptics
* Mannitol
* Hypertonic saline
* Head of bed position (as possible)
*Avoid using albumin due to increased mortality.

=== Emergence ===

== Postoperative management ==

=== Disposition ===
Neuro critical care unit

=== Pain management ===

=== Potential complications ===

== Procedure variants ==

{| class="wikitable wikitable-horizontal-scroll"
|+
!
!Variant 1
!Variant 2
|-
|Unique considerations
|
|
|-
|Position
|
|
|-
|Surgical time
|
|
|-
|EBL
|
|
|-
|Postoperative disposition
|
|
|-
|Pain management
|
|
|-
|Potential complications
|
|
|}

== References ==
https://pubmed.ncbi.nlm.nih.gov/23194432/
[[Category:Surgical procedures]]

Craniotomy for trauma

2022-07-18T15:03:04Z

Huckfinne:

Terbutaline

2022-07-18T14:13:06Z

Huckfinne: add adverse effects

{{Infobox drug reference
| trade_names =
| drug_class = Beta agonist
| drug_class_color = cardiovascular_agonist
| uses = Tocolysis
| contraindications =
| routes = IV, SC
| dosage =
| dosage_calculation = terbutaline
| mechanism = Beta-2 agonism
| adverse_effects =
| time_onset =
| duration =
| metabolism =
| halflife_redistribution =
| halflife_elimination =
| clearance =
| protein_binding =
}}

Provide a brief summary of this drug here.

==Uses==

==Contraindications==

===Absolute contraindications===

===Precautions===

==Pharmacology==

===Pharmacodynamics===

====Mechanism of action====

====Adverse effects====

* Hyperglycemia
* Hypokalemia
* Tachycardia

===Pharmacokinetics===

==Chemistry and formulation==

==History==

==References==

[[Category:Drug reference]]
[[Category:Adrenergic receptor modulators]]
[[Category:Beta agonists]]
[[Category:Beta-2 agonists]]
[[Category:Tocolytics]]

Opioids

2022-07-17T23:44:55Z

Huckfinne: add opioid receptors

==List of common opioids==

===Receptors===
μ1 - euphoria

μ2 - hypoventilation, constipation, dependent

δ - hypoventilation, constipation, dependent

κ - antagonize many of the μ effects and engenders diuresis

σ - dysphoria

===Opium alkaloids and semisynthetic derivatives===

====Opium alkaloids====
*[[Codeine]]
*[[Codeine|Morphine]]

====Semisynthetic derivatives====
*[[Buprenorphine]] (partial agonist)
*[[Hydrocodone]]
*[[Hydromorphone]]
*[[Naloxone]] (antagonist)
*[[Naltrexone]] (antagonist)
*[[Oxycodone]]

===Synthetic opioids===
*[[Alfentanil]]
*[[Fentanyl]]
*[[Meperidine]]
*[[Methadone]]
*[[Remifentanil]]
*[[Sufentanil]]

==Molecular structure==
<gallery widths="150px" heights="150px" perrow="4" caption="Molecular structure of opium alkaloids">
File:Codeine.svg|[[Codeine]]
File:Morphine.svg|[[Morphine]]
</gallery>
<gallery widths="150px" heights="150px" perrow="4" caption="Molecular structure of semisynthetic derivatives">
File:Hydrocodone.svg|[[Hydrocodone]]
File:Hydromorphone.svg|[[Hydromorphone]]
File:Oxycodone.svg|[[Oxycodone]]
File:Naloxone.svg|[[Naloxone]] (antagonist)
File:Naltrexone.svg|[[Naltrexone]] (antagonist)
File:Buprenorphine.svg|[[Buprenorphine]] (partial agonist)
</gallery>
<gallery widths="150px" heights="150px" perrow="4" caption="Molecular structure of anilidopiperidine opioids">
File:Alfentanil.svg|[[Alfentanil]]
File:Fentanyl.svg|[[Fentanyl]]
File:Remifentanil.svg|[[Remifentanil]]
File:Sufentanil.svg|[[Sufentanil]]
</gallery>
<gallery widths="150px" heights="150px" perrow="4" caption="Molecular structure of other synthetic opioids">
File:Meperidine.svg|[[Meperidine]]
File:Methadone.svg|[[Methadone]]
</gallery>

Succinylcholine

2022-07-17T23:41:21Z

Huckfinne: add absolute contraindications

{{Infobox drug reference
| trade_names = Anectine
| drug_class = Depolarizing neuromuscular blocker
| drug_class_color = succinylcholine
| uses = Paralysis for intubation
| contraindications = History/risk of [[Malignant hyperthermia|malignant hyperthermia]]<br />
Conditions which proliferate extrajunctional acetylcholine receptors
| routes = Intravenous, intramuscular
| dosage =
| halflife_elimination =
| image_file = Succinylcholine.svg
| protein_binding =
| clearance =
| time_onset = 30-60 seconds (IV)<br />
2-3 minutes (IM)
| halflife_redistribution =
| metabolism = Plasma cholinesterase
| duration = 5-10 minutes (IV)<br />
10-30 minutes (IM)
| adverse_effects = Bradycardia, hyperkalemia, malignant hyperthermia, myalgias
| dosage_calculation = succinylcholine
| mechanism = Depolarizing blockade of neuromuscular junction
| formula =
}}

'''Succinylcholine''', also known as '''suxamethonium''', is a short-acting neuromuscular blocker used during intubation.

==Uses==

==Contraindications==

===Absolute contraindications===

* hyperkalemia
* increased risk of [[Malignant Hyperthermia|malignant hyperthermia]]
* open globe injury
* allergy

===Precautions===

==Pharmacology==

===Pharmacodynamics===

====Mechanism of action====

====Adverse effects====

===Pharmacokinetics===

==Chemistry and formulation==

==History==

==References==
[[Category:Drug reference]]
[[Category:Neuromuscular blockers]]

Mastectomy

2021-11-04T21:27:15Z

Huckfinne: add no airway

{{Infobox surgical case reference
| anesthesia_type = General
| airway = ETT vs. LMA vs. spontaneous
| lines_access = PIV x 1-2
| monitors = Standard monitors
| considerations_preoperative = Place IV in non-operative extremity
| considerations_intraoperative =
| considerations_postoperative =
}}

A total '''mastectomy''' (simple mastectomy) refers to the complete removal of breast tissue. A modified radical mastectomy refers to the removal of the breast and the corresponding axillary lymph nodes.

== Preoperative management ==

=== Patient evaluation ===
{| class="wikitable"
|+
!System
!Considerations
|-
|Neurologic
|
|-
|Cardiovascular
|Chemotherapy (ex. anthracyclines) can cause cardiomyopathy that is often irreversible. Use of trastuzamab can cause reversible decrease in LV function.
|-
|Respiratory
|Patients receiving radiation therapy to the chest/thorax can have respiratory compromise
|-
|Gastrointestinal
|
|-
|Hematologic
|Chemotherapy can cause anemia and thrombocytopenia.
|-
|Renal
|
|-
|Endocrine
|
|-
|Other
|
|}

=== Labs and studies ===

* CBC with diff and platelet count
** May have anemia or thrombocytopenia due to chemo
* EKG
* Consider echo
** May have cardiomyopathy due to chemotherapy

=== Operating room setup ===

=== Patient preparation and premedication ===

* Consider acetaminophen, gabapentin and/or celecoxib
* Anxiolysis, as needed
* ERAS protocol

=== Regional and neuraxial techniques ===

* Consider paravertebral blocks, transversus abdomens plane (TAP) block, or thoracic epidural
* Studies have shown a trend towards increasing utilization of peripheral nerve blocks (PNB) for mastectomy. As of 2018, ~13% of cases involved a PNB according to the National Anesthesia Clinical Outcomes Registry<ref>{{Cite journal|last=Lam|first=Stephanie|last2=Qu|first2=Helena|last3=Hannum|first3=Margaret|last4=Tan|first4=Kay See|last5=Afonso|first5=Anoushka|last6=Tokita|first6=Hanae K.|last7=McCormick|first7=Patrick J.|date=2021-05-24|title=Trends in Peripheral Nerve Block Usage in Mastectomy and Lumpectomy: Analysis of a National Database From 2010 to 2018|url=https://journals.lww.com/anesthesia-analgesia/Abstract/9900/Trends_in_Peripheral_Nerve_Block_Usage_in.56.aspx|journal=Anesthesia & Analgesia|language=en-US|pages=10.1213/ANE.0000000000005368|doi=10.1213/ANE.0000000000005368|issn=0003-2999}}</ref>.

== Intraoperative management ==

=== Monitoring and access ===

* PIV x 1-2 (non-operative extremity)
* Place BP cuff on non-operative extremity

=== Induction and airway management ===

* Standard induction

=== Positioning ===

* Supine
* Ipsilateral arm may be prepped into field
* Repositioning may be required
* Avoid brachial plexus stretch
* Repositioning may be required if reconstruction is also being done (i.e. latissimus doors flap)

=== Maintenance and surgical considerations ===

* Standard maintenance
* Surgeon may prefer no paralytic for the axillary direction
* Maintain normovolemia -goal-directed fluid management
* Maintain normothermia - warming blanket
* Avoid anemia and blood transfusions
* Watch out for potential pneumothorax with deep surgical exploration

=== Emergence ===

* PONV prophylaxis (females are more susceptible to PONV)

== Postoperative management ==

=== Disposition ===

* PACU

=== Pain management ===

* Emphasize multimodal pain management

=== Potential complications ===

* PONV
* Lymphedema
* Seroma
* Pneumothorax

== Procedure variants ==

{| class="wikitable"
|+
!
!Total mastectomy
!Modified radical mastectomy
|-
|Unique considerations
|
|
|-
|Position
|
|
|-
|Surgical time
|
|
|-
|EBL
|
|
|-
|Postoperative disposition
|
|
|-
|Pain management
|
|
|-
|Potential complications
|
|
|}

== References ==

[[Category:Surgical procedures]]