Anesthesiology

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• Difficult Airway Strategy - Plan A B C with Rescue Options

  A difficult airway plan should anticipate failure before induction and specify oxygenation, intubation, rescue supraglottic ventilation, and emergency invasive airway options. The 2022 ASA guideline emphasizes deciding whether awake airway management is safer, limiting repeated attempts, maintaining oxygen delivery throughout the process, and moving deliberately through backup plans rather than persisting with a failing technique.

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• Extubation Strategies — High‑Risk Airways

  Plan extubation carefully in patients with edema, OSA/obesity, airway surgery, or difficult intubation. Use cuff‑leak tests, steroids, airway exchange catheters, and staged extubation techniques.

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• Local Anesthetic Systemic Toxicity - Lipid Emulsion and Resuscitation

  Local anesthetic systemic toxicity (LAST) is a rare but potentially fatal complication of local or regional anesthesia caused by excessive systemic local anesthetic exposure. Neurologic excitation or depression may precede cardiovascular collapse, but presentation can be atypical. Stop local anesthetic administration, secure oxygenation and ventilation, control seizures, give 20% lipid emulsion early for severe toxicity, use modified resuscitation principles, and mobilize extracorporeal support when shock o
• Local Anesthetic Systemic Toxicity — Recognition & Treatment

  Local anesthetic systemic toxicity (LAST) may begin with circumoral numbness, metallic taste, tinnitus, agitation, seizures, or sudden cardiovascular collapse after local-anesthetic exposure. Stop local anesthetic administration, call for help, secure oxygenation and ventilation, treat seizures with benzodiazepines, begin 20% lipid emulsion early for serious LAST, and use the ASRA-modified resuscitation approach while preparing for prolonged resuscitation or extracorporeal support when needed.

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• Malignant Hyperthermia — Dantrolene Protocol and Anesthetic Crisis Management

  Hypermetabolic crisis triggered by volatile anesthetics or succinylcholine. Stop triggers, call MH cart, give dantrolene promptly, and institute aggressive cooling and supportive care; treat hyperkalemia and acidosis, monitor for recrudescence.
• Malignant Hyperthermia Crisis - Dantrolene and Supportive Care

  Malignant hyperthermia is a hypermetabolic skeletal-muscle crisis triggered by volatile anesthetics and succinylcholine in susceptible patients. Early clues include an unexplained rise in end-tidal CO2, tachycardia, muscle rigidity, acidosis, hyperkalemia, and rapidly rising temperature. Stop triggering agents, hyperventilate with 100% oxygen, give IV dantrolene 2.5 mg/kg rapidly and repeat until the syndrome is controlled, cool dangerous hyperthermia, and treat metabolic complications.
• Multimodal Analgesia - Opioid Sparing Perioperative Plan

  Multimodal perioperative analgesia combines medications and techniques with different mechanisms to improve pain control while reducing opioid exposure and opioid-related adverse effects. Build the plan around the procedure, patient comorbidities, baseline opioid use, and expected pain trajectory. Use scheduled nonopioid analgesics when safe, local or regional anesthesia when appropriate, and selected adjuncts for higher-risk pain while reserving opioids for breakthrough or severe pain at the lowest effecti

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• Neuraxial Anesthesia and Anticoagulation - Timing and Catheter Management

  Neuraxial anesthesia and analgesia in patients receiving antithrombotic therapy require drug-specific timing for needle placement, catheter removal, and medication restart because spinal or epidural hematoma is rare but potentially catastrophic. Apply the current ASRA fifth-edition guideline, account for dose intensity, renal function and drug clearance, avoid traumatic placement when possible, and treat new postoperative back pain or neurologic deficit as an emergency until neuraxial hematoma is excluded.
• Neuromuscular Blockade Reversal - Sugammadex and Neostigmine

  Residual neuromuscular blockade after anesthesia increases the risk of airway obstruction, hypoventilation, aspiration, and pulmonary complications. Use quantitative neuromuscular monitoring at the adductor pollicis, confirm a train-of-four ratio of at least 0.9 before extubation, and select reversal according to blocker, depth of block, and clinical context. Sugammadex provides rapid, reliable reversal of rocuronium or vecuronium at moderate or deep block, while neostigmine is best reserved for shallow blo

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• Obstetric Hemorrhage — Anesthesia Management

  Obstetric hemorrhage requires immediate team activation, quantified blood-loss assessment, uterotonic treatment for uterine atony, early tranexamic acid when postpartum hemorrhage is diagnosed, rapid identification of trauma/tissue/thrombin causes, balanced blood-component resuscitation, warming and calcium management, fibrinogen-guided hemostatic support, and prompt procedural or surgical source control when bleeding continues.
• Obstructive Sleep Apnea - Perioperative Risk and Monitoring

  Obstructive sleep apnea (OSA) increases perioperative risk from upper-airway obstruction, hypoxemia, difficult airway management, sedatives, opioids, and residual neuromuscular blockade. Screen for known or suspected OSA, continue home positive-airway-pressure therapy when feasible, use opioid-sparing and regional techniques, ensure complete neuromuscular recovery before extubation, and match postoperative monitoring to OSA severity, procedure, opioid requirement, and observed respiratory events.
• One Lung Ventilation - Placement and Ventilation Basics

  One-lung ventilation (OLV) provides surgical exposure during thoracic procedures by ventilating one lung while allowing the operative lung to collapse. Correct lung-isolation device placement, bronchoscopic confirmation, and lung-protective ventilation are central to safe management. Use low tidal volumes based on predicted body weight, individualized PEEP, the lowest FiO2 that maintains adequate oxygenation, and a structured response to hypoxemia that begins with checking device position and ventilation be

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• Perioperative Anaphylaxis - Recognition and Epinephrine First

  Perioperative anaphylaxis often presents abruptly with hypotension, bronchospasm, difficult ventilation, angioedema, or cardiovascular collapse after exposure to antibiotics, neuromuscular blockers, chlorhexidine, latex, dyes, or other agents. Stop suspected triggers, call for help, give epinephrine promptly, support oxygenation and circulation with IV fluid, and obtain timed mast-cell tryptase samples for later allergy investigation.
• Perioperative Glycemic Control — Targets & Insulin

  For most adults with diabetes undergoing surgery, aim for perioperative glucose of about 100–180 mg/dL while avoiding hypoglycemia. Check recent glycemic control for elective surgery, hold SGLT2 inhibitors 3–4 days before elective procedures, hold metformin and other oral glucose-lowering drugs on the day of surgery, continue reduced basal insulin rather than omitting basal insulin entirely, and use scheduled subcutaneous or IV insulin according to procedure length and clinical acuity.
• Perioperative Hypotension - Causes and Vasopressor Choices

  Perioperative hypotension is a sign, not a diagnosis. Rapidly determine whether the dominant mechanism is vasodilation, hypovolemia or hemorrhage, myocardial dysfunction, obstructive physiology, anaphylaxis, or another cause while maintaining organ perfusion. Current perioperative cardiovascular guidance supports prompt treatment of intraoperative hypotension, commonly targeting at least a mean arterial pressure near 60 to 65 mm Hg or systolic pressure at least 90 mm Hg in adults, with higher individualized
• Perioperative Temperature Management - Active Warming and Monitoring

  Unintended perioperative hypothermia, generally core temperature below 36°C, increases bleeding, transfusion, wound infection, cardiac stress, shivering, drug effect, and recovery time. Identify high-risk patients, measure temperature consistently, minimize exposure, use active forced-air warming when indicated, and warm larger-volume IV fluids and blood products. Continue warming in recovery until the patient is comfortably normothermic and investigate unexpected or persistent hypothermia.
• Postoperative Delirium — Prevention & Management

  Postoperative delirium is an acute, fluctuating disturbance of attention and cognition that should trigger a search for precipitating illness, medication effects, pain, hypoxia, infection, urinary retention, constipation, metabolic abnormalities, and withdrawal. Prevention and treatment center on multicomponent nonpharmacologic care, orientation, sleep, mobility, sensory aids, hydration, analgesia, and medication review; reserve antipsychotics for severe agitation that threatens safety after reversible caus
• Postoperative Nausea and Vomiting - Risk Score and Multimodal Prophylaxis

  Postoperative nausea and vomiting (PONV) is common, distressing, and often preventable. Estimate baseline risk using factors such as female sex, nonsmoking status, prior PONV or motion sickness, and expected postoperative opioid exposure; reduce modifiable anesthetic risk; and use multimodal prophylaxis from different antiemetic classes for patients at risk. Treat breakthrough PONV promptly with an agent from a class not already used for prophylaxis whenever possible.
• Preoperative Assessment - ASA Class, Functional Capacity, and Risk Optimization

  Preoperative assessment estimates perioperative risk, identifies conditions that should be optimized before elective surgery, and prevents unnecessary testing. Combine procedure risk, ASA physical status, cardiovascular history, functional capacity, frailty, pulmonary risk, medication review, and targeted laboratory testing. Cardiac stress testing is reserved for patients in whom the result would change management, not ordered routinely because surgery is planned.
• Preoperative Fasting - Clear Liquids and Carbohydrate Drinks

  Preoperative fasting reduces pulmonary aspiration risk while avoiding unnecessarily prolonged dehydration and discomfort. For healthy patients undergoing elective procedures, current ASA guidance permits carbohydrate-containing clear liquids, with or without protein, until 2 hours before anesthesia. Traditional minimum fasting intervals remain approximately 2 hours for clear liquids, 4 hours for breast milk, 6 hours for infant formula, nonhuman milk, or a light meal, and 8 hours or more for fatty meals or m

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• Rapid Sequence Induction - Anesthesia Checklist and Essentials

  Rapid sequence induction is an airway strategy for patients at meaningful risk of aspiration or when rapid control of the airway is required. Success depends on preparation, preoxygenation, hemodynamic optimization, immediate administration of an induction agent and fast neuromuscular blocker, avoidance of unnecessary delays, and a predefined rescue plan. Modern RSI prioritizes oxygenation and safe first-pass success rather than rigid adherence to historical steps.
• Rapid Sequence Induction — High Aspiration Risk

  For high aspiration risk, employ optimized preoxygenation, rapid induction with cricoid pressure only if trained/indicated, and immediate paralysis/intubation; avoid mask ventilation unless hypoxic.
• Regional Anesthesia for Hip Fracture — Fascia Iliaca/Capsular Blocks

  Fascia iliaca and pericapsular nerve group (PENG) blocks provide superior analgesia for hip fracture, facilitating positioning and reducing opioids. Use ultrasound guidance and adequate volumes.

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• Total Intravenous Anesthesia (TIVA) — Indications & Setup

  TIVA provides hypnosis/analgesia via IV infusions (e.g., propofol ± remifentanil/ketamine). Indicated for PONV risk, airway surgery, neuromonitoring, MH susceptibility, and when volatile avoidance desired.

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• Ultrasound‑Guided Peripheral IVs — Tips & Tricks

  Use ultrasound to cannulate deep forearm/brachial veins when landmarks fail. Prioritize vein selection, catheter length, needle‑tip visualization, and securement to prevent early failure.