Anesthesiology Quick Reference

Section I: Systems-Based (Comorbidities & Conditions)

Airway

  • Difficult Airway (anticipated)
    • Signs: limited mouth opening, Mallampati III–IV, reduced neck mobility.
    • Action: prepare adjuncts (video laryngoscope, bougie, supraglottic device).
    • Backup: surgical airway plan; call for help early.
  • Aspiration Risk
    • High-risk: full stomach, GERD, obesity, pregnancy, trauma.
    • Action: RSI with cricoid pressure, preoxygenation, HOB up.
    • Drugs: avoid long-acting NMBDs if rapid extubation expected.
  • Obstructive Sleep Apnea (OSA)
    • Risks: airway collapse, postop hypoventilation.
    • Action: CPAP periop, minimize opioids, extubate fully awake.
    • Warning: high sensitivity to sedatives.
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Cardiac

  • Severe Aortic Stenosis
    • Goals: maintain afterload, sinus rhythm, avoid tachy/brady, maintain preload.
    • Avoid: vasodilators, hypotension.
    • Preferred induction: etomidate/ketamine (careful), gentle intubation.
  • Ischemic Heart Disease / CAD
    • Goals: maintain O₂ supply/demand balance.
    • Action: continue beta-blockers, avoid tachycardia.
    • Drugs to avoid: ketamine, high-dose phenylephrine (↑afterload).
  • Heart Failure (reduced EF)
    • Goals: avoid volume overload, maintain forward flow.
    • Induction: etomidate, avoid propofol bolus.
    • Support: inotropes ready (epi, milrinone).
  • Hypertrophic Cardiomyopathy
    • Goals: maintain preload/afterload, avoid tachycardia/↑contractility.
    • Avoid: inotropes, vasodilators.
    • Preferred: beta-blockade, phenylephrine for BP support.
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Pulmonary

  • Severe Asthma/COPD
    • Goals: avoid bronchospasm, minimize air trapping.
    • Induction: ketamine or propofol; lidocaine helpful.
    • Ventilation: long expiratory time, low tidal volume.
  • Pulmonary Hypertension
    • High-risk: RV failure, sudden death under GA.
    • Avoid: hypoxia, hypercarbia, acidosis.
    • Drugs: avoid nitrous, ketamine; consider nitric oxide/epoprostenol backup.
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Renal / Hepatic

  • End-Stage Renal Disease (ESRD)
    • Issues: electrolyte imbalance (K⁺), fluid overload, anemia.
    • Action: check dialysis timing; avoid K-sparing drugs, Mg.
    • Drugs: avoid morphine/meperidine (toxic metabolites).
  • Liver Cirrhosis
    • Issues: coagulopathy, ascites, encephalopathy, varices.
    • Action: check INR/platelets; maintain hepatic flow.
    • Avoid: hepatotoxic drugs, excessive fluid overload.
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Metabolic

  • Diabetes / Insulin Pump
    • Preop: check BG, last insulin dose.
    • Intraop: maintain 120–180 mg/dL.
    • Caution: hypoglycemia under anesthesia often silent.
  • Morbid Obesity
    • Risks: difficult airway, aspiration, rapid desat, OSA.
    • Action: ramped position, high PEEP, CPAP postop.
    • Dosing: use IBW for induction, TBW for succs.
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Neuro

  • Stroke / Recent TIA (<3mo)
    • Risk: high periop re-stroke.
    • Goals: maintain normotension, avoid swings.
    • Avoid: hyper/hypocapnia.
  • Raised ICP / Intracranial Pathology
    • Goals: avoid ↑ICP (hypercarbia, hypoxia, straining).
    • Action: propofol, mannitol, controlled ventilation.
    • Avoid: ketamine, nitrous.
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Drugs & Reversal

  • Anticoagulation (Warfarin/DOACs)
    • Check: INR or last dose timing.
    • Neuraxial: strict ASRA timelines.
    • Reversal: PCC, vitamin K, idarucizumab, andexanet (expensive).
  • Chronic Opioid Use
    • Risks: tolerance, withdrawal.
    • Action: maintain baseline opioids, multimodal analgesia.
    • Avoid: abrupt cessation.
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OB / Trauma

  • Obstetric Hemorrhage
    • Risks: rapid blood loss, coagulopathy.
    • Action: activate MTP, uterotonics, TXA, large-bore IVs.
    • Goals: maintain uterine tone, volume resuscitation.
  • Massive Transfusion Protocol
    • Goals: balanced resuscitation (1:1:1 RBC:FFP:Plt).
    • Action: warmers, calcium chloride after 4–6 units blood.
    • Avoid: dilutional coagulopathy.
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Pediatric (General Pearls)

  • Airway: laryngospasm common (suction, jaw thrust, PPV, atropine if severe).
  • Fluids: isotonic (Plasmalyte/NS), bolus 10–20 mL/kg for hypotension.
  • Drug dosing: strictly weight-based; double-check conversions.
  • Apnea risk: ex-preterm <60 weeks PCA → admit overnight for monitoring.
  • Hypothermia: aggressive warming (room temp, Bair Hugger, warm IV fluids).
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Section II: Procedure-Based

Cardiac

  • CABG / Open Heart
    • Goals: maintain hemodynamic stability, manage anticoagulation, protamine reversal.
    • Pitfalls: massive blood loss, arrhythmias, prolonged bypass.
  • Carotid Endarterectomy (CEA)
    • Goals: maintain cerebral perfusion (avoid hypotension), tight BP control.
    • Pitfalls: clamp intolerance, stroke, neck hematoma.
  • AAA Repair (open or EVAR)
    • Goals: preload/afterload swings during clamp/unclamp.
    • Pitfalls: massive bleeding, renal ischemia, spinal cord ischemia.
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Thoracic

  • Thoracotomy / Lung Resection
    • Goals: OLV, oxygenation, minimize barotrauma.
    • Pitfalls: hypoxia during OLV, bleeding, postop pain.
  • Mediastinoscopy
    • Goals: hemodynamic stability, avoid PEEP.
    • Pitfalls: great vessel compression, vagal reflex, air embolism.
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Abdominal / General

  • Laparoscopic Cholecystectomy
    • Goals: tolerate pneumoperitoneum, positioning.
    • Pitfalls: vagal bradycardia, CO₂ absorption, shoulder pain.
  • Laparoscopic Bariatric Surgery
    • Goals: optimize airway, high PEEP.
    • Pitfalls: desaturation, difficult extubation, rhabdomyolysis.
  • Whipple (Pancreaticoduodenectomy)
    • Goals: fluid/blood readiness, long duration.
    • Pitfalls: delayed gastric emptying, hypoglycemia.
  • Colectomy (open/lap)
    • Goals: fluid optimization, hemodynamic stability.
    • Pitfalls: blood loss in open cases, ileus postop.
  • Liver Resection
    • Goals: low CVP during resection, maintain hepatic perfusion.
    • Pitfalls: bleeding, liver failure, air embolism.
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ENT / Airway

  • Tonsillectomy / Adenoidectomy
    • Goals: secure airway, minimize PONV/bleeding.
    • Pitfalls: laryngospasm, aspiration of blood.
  • Thyroidectomy / Parathyroidectomy
    • Goals: avoid recurrent laryngeal nerve injury, smooth emergence.
    • Pitfalls: hematoma → airway obstruction, hypocalcemia.
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Neuro / Spine

  • Craniotomy for Tumor
    • Goals: brain relaxation, stable hemodynamics.
    • Pitfalls: venous air embolism, seizures, blood loss.
  • Spine Surgery (lumbar fusion, scoliosis)
    • Goals: large-bore access, blood conservation, positioning.
    • Pitfalls: blood loss, spinal cord ischemia, postop visual loss.
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OB / GYN

  • Cesarean Section (emergent vs elective)
    • Elective: spinal/epidural; GA if contraindicated.
    • Emergent: RSI, hemorrhage vigilance.
    • Pitfalls: aspiration risk, exaggerated anesthetic response.
  • Hysterectomy (open vs lap)
    • Goals: hemodynamic stability, multimodal analgesia.
    • Pitfalls: blood loss, ureteral injury, DVT risk.
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Ortho / Trauma

  • Hip Fracture (elderly)
    • Goals: minimize swings, early mobilization.
    • Pitfalls: anticoagulation, fat embolism, cardiac risk.
  • Total Joint Arthroplasty (hip/knee)
    • Goals: regional when possible, blood conservation.
    • Pitfalls: cement syndrome, DVT/PE.
  • Polytrauma / Damage Control Surgery
    • Goals: airway first, permissive hypotension if no TBI.
    • Pitfalls: coagulopathy, hypothermia, acidosis.
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Urology

  • TURP / TURBT
    • Goals: monitor for TURP syndrome, normothermia.
    • Pitfalls: bleeding, bladder perforation, obturator reflex.
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Pediatric (Specific Cases)

  • Inguinal Hernia Repair
    • Risks: airway reactivity, apnea risk if ex-preterm <60 wks PCA, hypothermia.
    • Goals: smooth inhalation induction, caudal/ilioinguinal block.
    • Pitfalls: bradycardia with sevo; postop apnea monitoring if risk factors.
  • Tonsillectomy / Adenoidectomy (non-complex OSA vs non-OSA)
    • Risks: airway obstruction postop, laryngospasm, bleeding.
    • Goals: minimize opioids, multimodal analgesia.
    • Pitfalls: OSA kids very opioid-sensitive; monitor overnight if severe.
  • Myringotomy / Tympanostomy Tubes
    • Goals: mask induction, maintain spontaneous ventilation.
    • Pitfalls: laryngospasm, emergence agitation.
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