sedationstation

Mechanical Ventilation in Pregnancy The indications for intubation of a pregnant patient are no different than the non-pregnant patient. The guiding principle of ventilating the pregnant patient is ensuring adequate oxygen delivery. The goal is a PaO2 of >90 mmHg. Positive end-expiratory pressure (PEEP) should be applied to keep the FiO2 <60%, but the patient should be kept in the left lateral decubitus position to minimize the effect of PEEP on venous return. Permissive hypercapnia, a strategy used in acute lung injury, may lead to fetal distress. If higher PaCO2 levels are being sustained in the pregnant patient, then continuous fetal monitoring is required. Sedation with propofol and opioid drugs are safe, though the fetus may need to be intubated on delivery as these drugs cross the placenta. Benzodiazepines should be avoided as they have been shown to increase the incidence of cleft palate. Higher than normal peak and plateau airway pressures can be expected on the venti...

- Use is encouraged when expected surgical blood loss > 800 ml. - It is indicated when Hemoglobin value is between 10 and 13 without iron deficiency anemia. - Dose approved is 600 U/kg/week subcutaneously. - It is given in 3 injections.  - It should be started 3 weeks prior to surgery without exceeding hemoglobin target level of 15. - Monitor blood pressure before each injection. Ref. MAPAR 2014

Delta 0-3 Hz Deep sleep or deep anesthesia; hypoxia, hypocapnea, ischemia, Electrolyte disturbances Theta 4-7 Hz Sleep and anesthesia Alpha 8-13 Hz Resting, awake with eyes closed

Hemolytic Reactions Reaction Response Treatment Acute Hemolytic Transfusion Reaction Antibody reaction  + Complement fixation to rbc A, B, Kell, Kidd, Duffy and Ss antigens Hemolysis, acute renal failure, hypotension, bronchospasm, DIC Supportive measures: inotropes and vasopressors to prevent shock, maintain intravascular volume and urine output with IVF and diuretics Delayed Hemolytic Reactions   Prior sensitization to donor antigens (kidd, kell, Rh) – low levels of antibodies over time such that they are not detected on routine screening. Transfusion exposure causes an anamnestic response. Usually rbc destruction occurs extravascularly and symptoms are less severe than AHTR. Low grade fever, ↑ indirect bilirubin, jaundice, anemia Supportive, hydration and transfusion of compatible rbc as necessary       Nonhemolytic reactions       Minor Allergic Reactions Allergic reaction to donor plasma proteins Rash, pruritus, swelling Diphenhydra...

Steroid Glucocorticoid Potency Mineralocorticoid Potency Equivalent Dose Hydrocortisone 1 1 20 Prednisone 4 0.8 5 Prednisolone 4 0.8 5 Methylprednisolone 5 0.5 4 Triamcinolone 5 0 4 Dexamethasone 30-40 0 0.75

Drugs considered  safe  in patients with porphyria Drugs to  avoid  in patients with porphyria Sedatives : propofol, etomidate, nitrous oxide Sedatives : barbituates, diazepam, chlordiazepoxide Analgesics : fentanyl, meperidine, morphine, droperidol, procaine Analgesics : pentazocine, lidocaine Others:  promethazine, chlorpromazine,succinylcholine, pancuronium, neostigme, atropine Anticonvulsants : phenytoin Antibiotics : sulfonamides, chloramphenicol   Hypoglycemic agents : tolbutamide, clorpropamide   Others : ethanol, ergot derivatives, amphetamines, methyldopa, oral contraceptives