Avoiding Common Anesthesia Errors

AIRWAY AND VENTILATION
Basics
Advanced
Never neglect the basics of airway management
Basics of airway management-Part II (Tips and Tidbits)
Consider PEEP

Advanced:: A variety of techniques provide acceptable anesthesia for awakeintubation of the airway:: ultimately, the most important factorsare operator experience and adequate time
Special Cases:: A high inspired concentration of oxygen is contraindicated incertain circumstances
Remember that there are special considerations involved withboth intubation and chronic airway management of burn patients

Know how to perform a cricothyroidotomy
Perioperative Issues
Donts:: Do not overinflate the cuff of the endotracheal tube

Dont under represent the risks associated with the use of alaryngeal mask airway
Do not be intimidated by the placement and use of double-lumenendotracheal tubes
Do not underestimate the difficulty of reintubating a patient whohas undergone carotid endarterectomy or cervical spine surgeryDo not start the airway management of a Ludwig angina patientuntil personnel and equipment for a definitive (surgical) airwayare assembled

LINES AND ACCESSBasics::Remember that the IV start is your first chance to make a favorableimpression on the patient
Never use an intravenous line without palpating and inspectingit visually
Use of ultrasound guidance for cannulation of the central veinsimproves success rates, decreases number of attempts, and lowerscomplication rates

Central Lines::Central line placement:: never neglect the basics
Approach the use of a pulmonary artery catheter with caution
Avoid technique-related central venous catheter complicationsby using modern tools

Donts:: Dont overflush lines

Do not use the subclavian vein for central access of any type in apatient planned for dialysis

Errors:: Remember that inadvertent intra-arterial injection is not rare
Avoid errors in invasive blood pressure measurement
Remember that loss of a patent hemodialysis fistula in theperioperative period is a serious event for the patient and requiresimmediate communication with the surgeons

FLUIDS, RESUSCITATION, ANDTRANSFUSIONFluids:: Hypertonic saline:: the solution to the solution problem?
Remember that the synthetic colloid solutions have distinctproperties and risk/benefit ratios

Resuscitation::Protect the kidneys, not the UOP
Do not treat lactic acidosis with bicarbonate
Consider the use of tris-hydroxymethyl aminomethane (THAM)to treat refractory or life-threatening metabolic acidosis
Use the principles of damage control anesthesia in the care ofthe massively bleeding patient and ask the surgeons to implementdamage control surgery if necessary
Routine Labor and DeliveryLearn from the care of the combat victim:: ask the surgeons toconsider damage control surgery for the bleeding patient

Transfusion::Know what screening tests are performed on volunteer donorblood
Transfusion of packed red blood cells requires a careful riskbenefitanalysis

MEDICATIONS Perioperative issues::

INTRAOPERATIVE AND PERIOPERATIVE Basics::

REGIONAL ANESTHESIA

PACU

PEDIATRIC ANESTHESIA

NEUROANESTHESIA

CARDIAC ANESTHESIA

OB ANESTHESIA

PAIN MEDICINE

HUMAN FACTORS

LEGAL

PROFESSIONAL PRACTICE

CODING AND PAYMENT-MAKE SURE YOUGET PAID

COMMENCEMENT

Index