- See:
- Anesthesia and Timing for Femoral Neck Fractures: 
- Anesthesia in the Spinal Cord Injured Patient:
- Cardiac Orders / Meds:
- Malignant Hyperthermia:
- Risk Assessment:
- Anesthetic Agents:
- Lidocaine:
- Bupivacaine:
- Thiopental:
- Narcotics
- Intubation Technique:
- cricothroidectomy / NEJM Cricothyroidotomy / The Jaw-Thrust Maneuver
- intubation menu
- bag and mask ventilation
- EMERGENCY WAR SURGERY Airway/Breathing
- Conscious Sedation: (for fracture reduction)
- while it is important to enquire when the patient last ate, narcotics and IV sedation should not be withheld or delayed for fear
of vomiting, since a pain ileus may cause stomach contents to remain stagnant for hours;
- use anesthetic agents which can be reversed by pain stimulus (such as narcotics and benzodiazepines;
- if respiratory depression occurs, the patient can be gently woken by a gentle manipulation of the injured extremity;
- there is rarely a need to use narcan;
- insist that patients are placed on a pulse ox monitor w/o oxygen (unless of course the O2 sats are less than 90%)
- as long as supplemental oxygen is not used, the pulse ox will serve as a crude respiratory monitor and can alert MD to pending respiratory depression;
- if supplemental O2 is added (as a routine protocol) then respiratory depression can occur (w/ toxic build up of CO2) while O2 sats will be relatively maintained;
- references:
- Safe and effective IV regional anesthesia for use in the emergency department.
- Intravenous regional anesthesia: a safe and cost-effective outpatient anesthetic for upper extremity fracture treatment in children.
- A Comparison of Pediatric Forearm Fracture Reduction Between Conscious Sedation and General Anesthesia
- Pediatric Anesthesia:
Society for Pediatric Anesthesia
- The Virtual Anaesthesia Textbook: Anesthesia for Infants and Children
- Pediatric Anesthesiology: The Basics
- Pediatric Cocktail:
- demerol (2mg/kg), Thorazine (1mg/kg), phenergan (1mg/kg);
- references:
- Self-administered nitrous oxide and a hematoma block for analgesia in the outpatient reduction of fractures in children.
- Intravenous sedation for the closed reduction of fractures in children.
- Analgesia for the reduction of fractures in children: a comparison of nitrous oxide with intramuscular sedation.
- Intravenous regional anesthesia in the treatment of forearm and wrist fractures and dislocations in children.
- Outpatient treatment of upper extremity injuries in childhood using intravenous regional anaesthesia.
- Intravenous regional anaesthesia for the treatment of upper limb injuries in childhood.
- Comparing Effectiveness of Modified Forearm and Minidose Intravenous Regional Anesthesia for Reduction of Distal Forearm Fractures in Children.
- A Comparison of Pediatric Forearm Fracture Reduction Between Conscious Sedation and General Anesthesia
- Type of Blocks:
- Drug Interactions:
- echothiophate drops:
- used in the treatment of glaucoma
- inhibit pseudocholinesterase
- can prolong the action of succinylcholine;
- Psychotropic drugs can have significant cardiovascular interactions;
- tricyclic antidepressants have significant anticholinergic effects;
- combination of halothane, pancuronium, and tricyclic antidepressants, can cause severe ventricular arrhythmias;
- MAOI
- can potentiate the depressive effects of narcotics;
- can cause fever and seizures when administered to a patient receiving MAOI;
- pressor effect of indirectly acting agents such as ephedrine may be greatly exagerated;
- traditional recommendations are that MAOI be discontinued 2 weeks before surgery;
- cocaine intoxication:
- severe hypertension, arrhythmias, and myocardial ischemia
- Positioning:
- brachial plexus may be stretched by abduction of the arm greater than 90 deg, esp if there is external rotation
- Facial Fractures and Upper Airway Injuries:
- see CMF injuries:
- in pts with major frxs of the mandible and maxilla (Lefort III) in whom massive edema has yet to occur, oral intubation is preferred, and
if required is usually easily accomplished;
- blind nasal intubation following major facial injury is discouraged because of the hazard of potential false passages into nasal sinuses and
cranial vault;
- injuries of the Larynx may cause rapid respiratory obstruction and require immediate tracheostomy;
- in less urgen situation, a history of trauma to the head and neck, stridor, hoarseness, and crepitus in the neck are all suggestive or
laryngeal injury
Anesthetic management for the child with Charcot-Marie-Tooth disease.
The influence of an anesthetic regimen on patient care, outcome, and hospital charges.
Preoperative drinking does not affect gastric contents.
Year Book: Timing of Osteosynthesis of Major Fractures in Patients With Severe Brain Injury.
Distal forearm regional block anesthesia for carpal tunnel release.
- American Society of Regional Anesthesia and Pain Medicine
- The New York Association of Regional Anesthesia: Step by step instruction on all aspects of regional blocks
- Bier block anesthesia:
- references:
- The use of muscle relaxant to supplement local anaesthetics for Bier's blocks.
- Safe and effective IV regional anesthesia for use in the emergency department.
- Year Book: Compartment Syndrome: A Complication of Intravenous Regional Anesthesia in the Reduction of Lower Leg Shaft Fractures.
- Wrist block
- radial nerve block
- median nerve block
- ulnar nerve blocks
- Ankle block
- tibial nerve block
- superficial and deep peroneal nervel blocks
- saphenous nerve block
- sural nerve block
- Axillary and Scalene block:
- contraindications:
- respirator insufficiency:
- expect blockade of the ipsilateral phrenic nerve (decreases pulmonary function);
- severe uncontrol seizure disorder
- ipsilateral neurologic disorder
- coagulopathy;
- references:
- Regional anesthesia preferable for Colles' fracture. Controlled comparison with local anesthesia.
- Regional anaesthesia and subsequent long-term pain.
- 100% Incidence of Hemidiaphragmatic Paresis Associated With Interscalene Brachial Plexus Anesthesia as Diagnosed by Ultrasonography.
- Regional anesthesia for microvascular surgery: a combination of brachial plexus, spinal, and epidural blocks.
- Interscalene block anesthesia for shoulder surgery.
- Digital anesthesia:
- references:
- Modified transthecal digital block versus traditional digital block for anesthesia of the finger.
- Transthecal digital block: digital anaesthesia through the sheath of the flexor tendon.
- Transthecal digital nerve block. An anatomical appraisal.
- Comparison of transthecal and subcutaneous single-injection digital block techniques in cadaver hands.
- Transthecal digital block: flexor tendon sheath used for anesthetic infusion.
- Spinal and epidural:
- references:
- The effect of intravenous fixed-dose heparin during total hip arthroplasty on the incidence of deep vein thrombosis. A randomized, double-blind trial in patients operated on with epidural anesthesia and controlled hypotension.
- Efficacy of epidural anesthesia in free flaps to the lower extremity.
- Prevention of thromboembolism following elective hip surgery. The value of regional anesthesia and graded compression stockings.
- Continuous epidural analgesia using fentanyl and bupivacaine after total knee arthroplasty.
- Spinal anaesthesia or general anaesthesia for emergency hip surgery in elderly patients.
- Regional anesthesia for foot and ankle surgery.
- Thromboprophylaxis and neuraxial anesthesia.
Emergent cricothyroidotomy in the morbidly obese: a safe, no-visualization technique