Category Archives: Adrenal

Anesthesia and Pain Management for the Surgeon – Highlights – Notes

PRIS – Propofol Infusion Syndrome – can be fatal. Cardiac failure, rhabdomyolysis, and a severe metabolic acidosis.
Adrenal insufficiency secondary from Etomidate (induction agent) administration may be a cause of hypotension in the post op surgical patient.
Dexmedetomidine (Precedex)has analgesic properties, sedation, stable respiratory rates, predictable cardiovascular responses.
Ativan should not be discountinued abruptly after long term use in the ICU patient.
Heterotopic calcification and myopathies are complications of long term chemical paralysis – thus chemical paralysis for ventilated patients are now not as popular.
Pulse oximetry readings not as accurate in patients with smoke inhalation.
Colorimetric CO2 indicator – stomach intubation can still change the color, initially.
CNS and Cardiotoxity related to local anesthetic use – a concern when intercostal nerve blocks used for multiple rib fractures. Lidocaine info
Place/Pull epidural catheters, won’t do unless lovenox/heparin sq held for 24 h.
As doses and duration of Metaclopramide (Reglan – Dopaminergic blocker) increases – neurologic side effects (movement disorders) also increases.
Oral to IV morphine is 3:1
Main use for LMA is for short cases in operating room. There are concerns for vomiting and aspiration.

Imidazole
Short acting IV anesthetic
Hypnotic effects
Amnestic properties, no analgesic properties
works through the GABA adrenergic system
Used often in Rapid Sequence Intubation
Short duration of action, rapid onset
Excellent hemodynamic profile
Cerebroprotective effects including reduction of intracranial pressure. Used with patients with traumatic brain injury.
Etomidate has hemodynamic stability which is better than all other induction agents except possibly Ketamine.
Post operative vomiting is more common with Etomidate than with other induction agents.
Requires a slow push for intubation induction otherwise one will get trismus
Onset of action is 30-60 seconds.

Useful when cross-sectional imaging is negative and an ectopic pheochromocytoma is suspected.

Uses a radiactive substance (tracer) and a scanner to find the presence of pheochromocytoma or neuroblastoma.
MIBG is the radioisotope. metaiodobenzylguanidine
Patients are sometimes given an iodine mixture to prevent the thyroid gland from absorbing too much of the radioisotope.
90% sensitive for detection of pheochromocytomas
FDOPA (fluoro-Dopa) PET/CT scan is also available for the detection of pheochromocytomas