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What is the preferred type of fluid administered during anesthesia?
LRS 5-10 ml/kg/h
What is an example of relative hypovolemia? Absolute hypovolemia?
- Relative - vasodilation
- Absolute - Dehydration & blood loss
What type of fluid has a higher concentration than plasma, interstitial and intracellular concentration of solutes and causes fluid to be drawn into intravascular space?
What type of fluid has similar concentration of solutes to plasma and interstitial space and there is proportional distribution of water to both spaces?
How much of isotonic fluid administered will distribute to the interstitial space?
What type of fluid has a lower concentration of solutes than plasma and interstitial space and most of the fluid administered will not stay in the intravascular space?
What type of fluid is acidifying and is not usually used during anesthesia except in patients with metabolic alkalosis?
Isotonic crystalloids (0.9% NaCl)
What type of fluid is alkalinizing and used for anesthesia management? 3
What is hetastarch used to treat under anesthesia? 5
- Hypotension due to:
- Hypovolemic and septic shock
- COP support
What fluid is used to rapidly produce plasma volume expansion under anesthesia?
What dextrose solution should be administered to patients needing fluids?
2.5% or 5%
What fluid should be given to manage blood loss acutely?
Balanced isotonic crystalloid solution at a rate of 3X the volume blood lost
When should anesthesia patients be administered less than maintenance fluid? 3
- Cardiac disease
- Pulmonary contusions
What is daily fluid maintenance rate usually? Anesthesia fluid maintenance rate?
- Daily - 2-2.5 ml/kg/hr
- Anesthesia - 5-10 ml/kg/hr
During hypovolemic or distributive shock, how much hypertonic saline should be administered?
4-7 ml/kg IV bolus in combo with isotonic crystalloids over 5-10 minutes
During anesthesia how much hetastarch should you administer to combat relative hypovolemia?
5 ml/kg IV bolus over 5-10 minutes
What should be administered after a patient loses more than 20% it's blood volume?
Hypertonic saline or hetastarch
What does blood loss of more than 30% require?
Transfusion with whole blood or pRBC with FFP
What is typical in unwarmed surgical patients and reflects failure of effective themoregulatory defenses caused by administered drugs?
What are some possible causes of hypothermia? 3
- Peripheral vasodilation
- Decreased metabolism and motion
- Large area nerve block
How much warmer are core temperatures compared to peripheral temperatures usually?
1-2 C warmer
What is the gold standard site of temperature measurement?
What are some possible sites to measure core temperatures? 4
- Tympanic membrane
- Pulmonary artery
- Distal esophagus
What are some possible sites to measure peripheral temperature? 5
- Skin surface
What patients have inreased interthreshold temperature ranges?
How much does anesthesia increase the interthreshold temperature range?
0.2-0.4 to 2-4 degrees C
What is the constant transfer of heat that occurs via electromagnetic waves and is the responsible for the majority of heat loss (50%)?
What is the process of heat exchange from the body surrounding fluid (IV fluid) or an air (fan) in bulk motion and is responsible for 30% loss?
Convection (fan or admin of cold IV fluids)
What is the process of heat exchange via direct interaction with a solid surface and is responsible for 10% loss?
Conduction (metal table or heating pad)
What is the process of metabolic heat lost via respiration and is responsible for 10% loss?
Evaporation (exposed visceral surface or alcohol on skin)
What are some possible ways to minimize hypothermia induced by anesthesia? 5
- Heat lamps
- Forced air warming blankets (most effective)
- Warm circulating water pads
How do you treat passive hyperthermia?
Remove active warming and insulation
What is the cause of excessive heat production (malignant hypertermia) during anesthesia?
Inhalant anesthetics leading to a lack of control of Ca2+ efflux from the endoplasmic reticulum