Handbook of Anesthesiology, 2004-2005 Edition by Mark Ezekiel

By Mark Ezekiel

This instruction manual is a present guide of Anesthesiology care, together with many helpful reference tables and charts. Anesthesiology is particularly well liked by clinical scholars, citizens, and anesthesiologists. New info on discomfort administration makes this publication crucial studying.

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Cardiovascular toxicity A. Local anesthetics depress myocardial automaticity (spontaneous phase IV depolarization) and reduce the duration of the refractory period (manifesting as prolonged PR interval and widening QRS. B. Myocardial contractility and conduction velocity are depressed at higher concentrations. Smooth muscle relaxation causes some degree of vasodilation (with the exception of cocaine). C. Cardiac dysrhythmia or circulatory collapse is often a presenting sign of local anesthetic overdose during general anesthesia.

3. Electrolyte abnormalities: hypokalemia and hypocalcemia augment a nondepolarizing block. Hypermagnesemia potentiates blockade. 4. Age: neonates have an increased sensitivity to nondepolarizing agents. 5. Drug interactions: drugs that potentiate nondepolarizing relaxants include volatile agents, local anesthetics, calcium channel blockers, aminoglycosides, polymyxins, lincosamines, hexamethonium, trimethaphan, immunosuppressants, high-dose benzodiazepines, dantrolene, and magnesium. 6. Synergistic blockade: may result when steroidal NMBD (vecuronium, rocuronium) are combined with benzylisoquinolines (atracurium).

6. Anesthetic considerations A. Preoperative 1. Preoperative evaluation of morbidly obese patients for major surgery should include a chest x-ray, EKG, arterial blood gas, and PFTs. 2. The airway should be carefully examined since these patients are often difficult to intubate as a result of limited mobility of the temporomandibular and atlanto-occipital joints, a narrowed upper airway, and a shortened distance between the mandible and increased soft tissue. 3. All obese patients are at an increased risk of aspiration and should be considered to have a full-stomach.

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