This document provides guidance on anesthetic considerations for the operating room/operating theater. It outlines key characteristics of an anesthesiologist including focusing on one patient, acting as a supportive psychotherapist for surgeons, and disliking chaos. It also discusses indicators for airway management, choices for induction hypnotics, maintaining sedation and preventing awareness, and effects of muscle relaxants. Additionally, it covers strategies for rising intracranial pressure, damage control resuscitation, and references for further reading on related topics such as fluid resuscitation, hemostasis monitoring, and hydroxyethyl starch use.

1. Anaesthetic
Consideration
s
in preparations for the
OR/OT
Joachim Unger,
MD

2. -Can only concentrate
on one patient
-Acts as supportive
psychotherapist for
surgeons
Hates
chaos
Characteristics of
an
anesthesiologist
no conflict of interests

4. Airway
Management
-Respiratory Insuffency:
RR <6 / >29
-GCS <9
-Hypoxia:
Sat < 90%
-Hemodynamic Instability: BP <90

5. Choise of
Induction
Hypnotics

6. Maintaining
Sedation
Prevention of
Awareness
No
Pain
No
Brain

7. Zeile 1 Zeile 2 Zeile 3 Zeile 4
0
2
4
6
8
10
12
Spalte 1
Spalte 2
Spalte 3
Effects of Muscle
Relaxants
Hyperkalemia
Oxygen consuming
Long-term
duration

8. Laryngoscopy #1
Laryngoscopy #2
(+/- Bougie)
Laryngoscopy #3
(Attending)
Laryngeal Mask Surgical Airway
Confirmation
Capnography
RSI

9. Video-Laryngoscopy
superior
to direct
Laryngoscopy?

10. Normoventilation
low tidal volume
adequate PEEP

11. Damage
Control
Resuscitatio
n
Acidosis
Hypocalcemia
Hypothermia
Permissive
Hypotention

12. Establish venous
access
No fluid
administration
in normotention

13. Second line:
Intraosseal
access

14. Arterial line
Glue it
Messure Pressure
Analyse Astrup

15. -free
Crystalloid
s
Starc
h is
outRestrictiv

16. Calcium and
Tranexamic Acid
Avoid
Hypocalcemia < 0,9
TXA: Early Administration
1g/10 min followed by 1g/8h

17. .
Transfusion
Hematocrit 25-30

18. Ratio
RBC:FF
P
1:1

19. Central
line
For massive Transfusion
Catecholamines can run initially peripherically

20. Temperature
control
Warmed
infusion
Warmed
blankets

21. Strategies
for
rising ICP Hyperventilation
Mannitol
Hypertone NaCl
7,5%Normoxie
Normocapnie
Normotonie
CCP > 50

22. Keep it
Safe and Simple
(KISS)

23. References I
Stephens CT et al. The Success of Emergency Endotracheal Intubation in Trauma Patients: A 10-Year
Experience at a Major Adult Trauma Referral Center. (Anesth Analg 2009;109:866–72)
Yeatts DJ et al. Effect of video laryngoscopy on trauma patient survival. J Trauma Acute Care Surg. 2013
Aug;75(2):212-9
Taha SK et al. Effect of suxamethonium vs rocuronium on onset of oxygen desaturation during apnoea
following rapid sequence induction. Anaesthesia. 2010 Apr;65(4):358-61
Wagner CE et al. Etomidate Use and Postoperative Outcomes among Cardiac Surgery Patients. Anesthesiology 2014; 579-89
Wang X et al. Ketamine does not increase intracranial pressure compared with opioids. J Anesth 2014
Futier E et al. A trial of intraoperative low-tidal-volume ventilation in abdominal surgery. NEJM 2013
Errando CL et al. Awareness with recall during general anaesthesia: a prospective observational evaluation
of 4001 patients. British Journal of Anaesthesia 101 (2): 178–85 (2008)
Turner J et al. (2000) A randomised controlled trial of prehospital intravenous fluid replacement therapy in
serious trauma. Health Technol Assess 4:1-57
Kozek-Langenecker S (2007) Monitoring hemostasis in emergency medicine. Yearb Intensive Care Emerg
Med 848-859

24. References II
Shakur H et al. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with
significant haemorrhage (CRASH-2) Lancet 2010; 376:23-32
Simonova G1 et al. Cyanoacrylate tissue adhesives - effective securement technique for intravascular catheters: in vitro testing
of safety and feasibility. Anaesth Intensive Care. 2012 May;40(3):460-6.
Wilkinson JN et al. Tissue adhesive as an alternative to sutures for securing central venous catheters. Anaesthesia. 2007
Sep;62(9):969-70.
Kwan I et al. (2003) Timing and volume of fluid administration for patients with bleeding. Cochrane Database Syst Rev
Bickell Wh et al. (1994) Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries.
NEJM 331:1105-1109
Annane D1 et al. Effects of fluid resuscitation with colloids vs crystalloids on mortality in critically ill patients presenting with
hypovolemic shock: the CRISTAL randomized trial. JAMA. 2013 Nov 6;310(17):1809-17.
John A. Myburgh et al. Hydroxyethyl Starch or Saline for Fluid Resuscitation in Intensive Care. NEJM 2012; 367:1901-1911
Richard PD. Damage Control Anesthesia. International TraumaCare (ITACCS) Fall 2005
Perner A. Et al. Hydroxyethyl Starch 130/0.42 versus Ringer's Acetate in Severe Sepsis. NEJM 2012; 367:124-134
Brunkhorst FM et al. Intensive Insulin Therapy and Pentastarch Resuscitation in Severe Sepsis (VISEP) NEJM 2008;358:125-
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