KEY FACTS IN ANAESTHESIA AND INTENSIVE CARE

Alcira Serrano Gomez

MD Fellow John Farman Intensive Care Unit Addenbrookes NHS Trust Cambridge, UK

Gilbert R Park
MD DMed Sci FRCA Director of Intensive Care Research John Farman Intensive Care Unit Addenbrookes NHS Trust Cambridge, UK

LONDON SAN FRANCISCO

 2003 Greenwich Medical Media Limited 137 Euston Road London NW1 2AA 870 Market Street, Ste 720, San Francisco, CA 94102 First published 2003 Apart from any fair dealing for the purposes of research or private study, or criticism or review, as permitted under the UK Copyright Designs and Patents Act 1988, this publication may not be reproduced, stored, or transmitted, in any form or by any means, without the prior permission in writing of the publishers, or in the case of reprographic reproduction only in accordance with the terms of the licences issued by the appropriate Reproduction Rights Organisations outside the UK. Enquiries concerning reproduction outside the terms stated here should be sent to the publishers at the London address printed above. The right of Alcira Serrano and Gilbert R Park to be identified as editors of this work has been asserted by him in accordance with the Copyright Designs and Patents Act 1988. While the advice and information in this book is believed to be true and accurate, neither the editors nor the publisher can accept responsibility or liability for any loss or damage arising from actions or decisions based in this book. The ultimate responsibility for treatment of patients and the interpretation lies with the medical practitioner. The opinions expressed are those of the editors and the inclusion in the book of information relating to a particular product, method or technique does not amount to an endorsement of its value or quality, or of the claims made of it by its manufacturers. Every effort has been made to check drug dosages; however, it is still possible that errors have occurred. Furthermore, dosage schedules are constantly being revised and new side effects recognised. For these reasons, the medical practitioners are strongly urged to consult the drug companies printed instructions before administering any of the drugs mentioned in this book. The publisher makes no representation, express or implied, with regard to the accuracy of the information contained in this book and cannot accept any legal responsibility or liability for any errors or omissions that may be made. A catalogue record for this book is available from the British Library. Project Manager Gavin Smith Typeset by Charon Tec Pvt. Ltd, Chennai, India Printed in the UK by The Alden Group Ltd, Oxford Distributed by Plymbridge Distributors Ltd and in the USA by Jamco Distribution Visit our website at www.greenwich-medical.co.uk

CONTENTS
Preface to second edition Preface to third edition Common abbreviations Useful telephone numbers Normal values Biochemistry Haematology Useful calculated values Resuscitation Adult cardiac arrest flow chart Cardiac arrest drugs and doses Paediatric cardiac arrest flow chart Paediatric cardiac arrest drugs and doses Resuscitation from shock Vasoactive drug infusions Which vasoactive agents to use when increasing cardiac index, blood pressure, DO2, etc. Normal cardiovascular variables and their calculation Treatment of arrhythmias The approach to the bleeding patient The assessment of bleeding disorders Massive blood transfusion Management of failed tracheal intubation Accidental intra-arterial injection Malignant hyperthermia Anaesthetic information Checklist for anaesthetic apparatus Minimal monitoring standards Mapleson circuits MAC values for adults and paediatric patients Guide to laryngeal mask airway (LMA) and tracheal tube sizes Adult anaesthetic and related drug doses vii ix xi xiii

1 2 2

4 5 6 7 8 12 12 13 13 16 16 16 17 18 19

22 24 25 26 26 28

Local anaesthetic maximum safe doses for regional analgesia Local anaesthetic blocks: drug doses Dermatome chart Paediatric anaesthetic information Paediatric anaesthetic and related drug doses Useful paediatric information Intensive care information and data Some aspects of ventilatory support Microbiology Managing pyrexia of unknown origin in the critically ill patient Oliguria and anuria Management of hyperkalaemia Sedation and analgesia in the critically ill Nutrition Half-lives and times to reach steady state of commonly used drugs in the critically ill Brain death Guidelines for organ donation Classification systems Glasgow coma scale Modified New York Heart Association (NYHA) functional classification of heart disease ASA classification of physical status Addenbrooke's sedation score Ramsay sedation score APACHE II: a severity of disease classification system National bodies in anaesthesia and specialist societies Bibliography

30 30 31

32 35

36 37 39 40 41 42 43 45 47 48

50 50 51 51 51 52 54 55

CONTENTS

vi

NORMAL VALUES

BIOCHEMISTRY Normal range

Blood: Urea and electrolytes Sodium Potassium Bicarbonate Glucose Urea Creatinine Chloride Osmolality Liver function tests Total protein Albumin Bilirubin Alkaline phosphatase Alanine aminotransferase Total calcium Ionised calcium Phosphate Zinc Magnesium Arterial blood gases Hydrogen ion pH PaCO2 PaO2 Base excess Standard bicarbonate Urine Sodium Potassium 132142 mmol/L 3.45 mmol/L 2230 mmol/L 3.57 mmol/L 7.5 mmol/L 35125 mol/L 95106 mmol/L 280300 mosmol/kg 6383 g/L 3044 g/L 217 mol/L 30135 U/L 740 U/L 2.22.6 mmol/L 1.181.30 mmol/L 0.81.4 mmol/L 1223 mol/L 0.71.0 mmol/L 3645 nmol/L 7.367.44 4.76 kPa 9.314 kPa 2.5 mmol/L 2125 mmol/L 50200 mmol/24 h 2060 mmol/24 h Continued

BIOCHEMISTRY (continued) Normal range

Urea Creatinine Protein Creatinine clearance Osmolality 330500 mmol/24 h 916 mmol/24 h 0.1 g/24 h 90120 mL/min 3001200 mosmol/kg

HAEMATOLOGY Normal range

Haemoglobin Men Women Platelet count White cell count (WCC) Differential white counts Neutrophils Lymphocytes Monocytes Eosinophils Basophils Prothrombin time (PT) Kaolin partial thromboplastin time (KPTT) Fibrinogen Fibrin-degradation products (FDPs) 14.017.0 g/dL 11.516.0 g/dL 150300 109/L 4.011 109/L 2.07.5 109/L (4075% of WCC) 1.54.4 109/L (2040% of WCC) 0.20.8 109/L (210% of WCC) 0.040.4 109/L (16% of WCC) 0.1 109/L ( 1% of WCC) 2 s above control 7 s above control 1.54.0 g/L 0.5 mg/L

USEFUL CALCULATED VALUES Osmolality

Plasma: osmolality (mosmol/kg) Urine: osmolality (mosmol/kg) [2 (Na K)] urea 10 [2 (Na K)] urea glucose

NORMAL VALUES

NORMAL VALUES
Creatinine clearance
Creatinine clearance (mL/min) Urine creatinine (mmol/24 h) Plasma creatinine ( mol/L) 694 9

Nitrogen balance
Nitrogen output (g/24 h) (urine urea 0.035) body weight (kg) 0.046) ( plasma urea

where plasma urea is the difference between one days result and the previous days.