Anesthesia for Surgical Subspecialties
Cardiothoracic
Understand one-lung ventilation, the physiology of the lateral decubitus position, and the management of hypoxia during thoracic surgery (CPAP to the non-dependent lung, PEEP to the dependent lung). Know the principles of cardiac anesthesia: cardiopulmonary bypass, heparinization and reversal, and the management of low cardiac output.
Neuroanesthesia
Understand cerebral blood flow autoregulation, the effects of CO2 and volatile agents on cerebral blood flow, and the goals of neuroprotection (normocapnia, normoglycemia, normothermia). Know the management of raised intracranial pressure and the sitting position.
Vascular
Know the management of carotid endarterectomy (regional versus general, monitoring of cerebral perfusion), abdominal aortic aneurysm repair (cross-clamping and declamping physiology), and the risks of peripheral vascular surgery in patients with cardiac disease.
Orthopedic
Understand the management of total hip and knee arthroplasty, the role of regional anesthesia, and the risk of fat embolism and bone cement implantation syndrome. Know the principles of tourniquet use and its systemic effects.
Transplant, ENT/Maxillofacial, Urologic, Obstetric, Pediatric
Know the key issues for each: transplant (immunosuppression, reperfusion), ENT (shared airway, bleeding), urologic (TURP syndrome, fluid absorption), obstetric (aspiration risk, aortocaval compression, preeclampsia), and pediatric (weight-based dosing, airway anatomy, congenital heart disease).
Traps
Questions often test the management of hypoxia during one-lung ventilation, the diagnosis of TURP syndrome (hyponatremia, hypervolemia), and the avoidance of succinylcholine in patients with hyperkalemia or neuromuscular disease.
Worked Example
During TURP, the patient becomes confused and hypertensive with a sodium of 118 mmol/L. This is TURP syndrome from absorption of hypotonic irrigant; stop surgery, correct sodium cautiously, and support ventilation.