More Notes from Anesthesiology...

I don't have the time or energy to tackle a large subject today but I will write down some information I was given that I think is important. 

On my first day, I learned about induction medications and the emergence process. I wrote that we induced all of my patients with Propofol. Today, we induced both of my pt's with Etomidate. I realized quickly that I knew what the induction medications were but I didn't know the reasoning behind choosing your anesthetic. 

Etomidate-This anesthetic has minimal depression of cardiovascular and pulmonary function.  Ideal for patients with coronary vascular disease, COPD or hemodynamic instablility. Both of my patients today had COPD and were receiving stent placements for aortic aneurysms. An interesting side effect of etomidate is adrenal suppression. I recall that we gave the patient a dose of steroids during the procedure today but I decided that the reason for this was because the patient was on steroids chronically for pain. Now that I am reading up on the medication, I am curious if we gave it in case the patient's adrenal glands were being suppressed. I will need to ask tomorrow. UPDATE: I asked and my attending said that although that it a side effect of Etomidate, it is not routine to give steroids in case there is adrenal gland suppression. 

The resident asked me about why we could not give Lactated Ringers through the warm IV. I tried my best to reason through and come up with an answer but failed miserably! I knew that you would run blood products through the warm IV but I couldn't think of why you wouldn't want to run Lactated Ringers through (contain Na, K, Cl, Lactate and Ca) along with the blood products. The reason is that PRBCs have citrate which chelates calcium. The citrate in the the PRBC could chelate the Ca in the Lactated Ringer solution and could cause a clot and ruin your IV. My resident also told me that there is a very small chance of this happening but a rule that they follow nonetheless. 

I was also reminded of the Mallampati score today as we saw our patients in preop and asked them to open their mouths and stick out their tongue. It helps give a quick assessment of how difficult your intubation may be. 

You give a patient a score depending on what structures you can see when they open their mouth and stick out their tongue. In a class one you can see the hard palate, soft palate, uvula and the pillars. Class two you can visualize the palate, portion of uvula and pillars. Class three you can visualize the soft palate and the base of uvula. Class four you can visualize the hard palate only. 

That's it for today! I am almost done with my first week of Anesthesiology! So far, I have been able to intubate a patient and help start a central line.