CPAN cheat sheet

ASA physical status: P1 healthy; P2 mild systemic disease; P3 severe systemic disease; P4 severe disease with constant threat to life; P5 moribund; P6 brain-dead organ donor; suffix E for emergency.

ASA fasting intervals before elective anesthesia: clear liquids 2 h; breast milk 4 h; infant formula 6 h; nonhuman milk and light meal 6 h; fatty or fried meal 8 h.

Aldrete score components: activity, respiration, circulation, consciousness, oxygen saturation; each scored 0-2, maximum 10; score ≥9 with stable vital signs commonly meets Phase I discharge criteria.

PADSS criteria: vital signs, ambulation, nausea/vomiting, pain, surgical bleeding; each scored 0-2; total ≥9 generally required for discharge after Phase II.

STOP-BANG: snoring, tiredness, observed apnea, hypertension, BMI >35, age >50, neck circumference >40 cm, male sex; score ≥3 increased OSA risk, ≥5 high risk.

Difficult airway predictors: Mallampati III-IV, thyromental distance <3 fingerbreadths, mouth opening <3 cm, short thick neck, limited cervical mobility, and prior difficult intubation.

Preoperative ECG and labs are indicated by age, comorbidities, medication effects, and procedure risk; routine testing without indication does not improve outcomes.

Malignant hyperthermia susceptibility history includes unexplained intraoperative fever, masseter rigidity, dark urine, or family history; trigger-free technique and dantrolene availability are required.

MAC values approximate: nitrous oxide 104%, desflurane 6%, sevoflurane 2%, isoflurane 1.15%, halothane 0.75%; lower MAC indicates greater potency.

MAC is additive: 0.5 MAC nitrous oxide plus 0.5 MAC sevoflurane equals approximately 1 MAC; 1 MAC prevents movement in 50% of patients to surgical stimulus.

Propofol induction 1.5-2.5 mg/kg IV; maintenance infusion 100-200 mcg/kg/min; rapid onset and short duration allow early discharge after ambulatory anesthesia.

Succinylcholine 1-1.5 mg/kg IV; onset 45-60 s; duration 5-10 min; contraindicated in hyperkalemia, burns >24 h, denervation injuries, and MH susceptibility.

Rocuronium intubating dose 0.6 mg/kg IV; rapid-sequence dose 1.2 mg/kg; sugammadex reversal 2 mg/kg for moderate block and 4 mg/kg for deep block; 16 mg/kg for immediate reversal.

Neostigmine 0.03-0.07 mg/kg IV (max 5 mg) with glycopyrrolate 0.2 mg per 1 mg neostigmine; reversal requires train-of-four monitoring and does not reliably reverse deep block.

Parenteral opioid equivalence: morphine 10 mg ≈ hydromorphone 1.5 mg ≈ fentanyl 100 mcg; adjust for age, renal/hepatic function, and opioid tolerance.

Lidocaine maximum 4.5 mg/kg without epinephrine and 7 mg/kg with epinephrine; bupivacaine maximum 2.5-3 mg/kg; LAST treatment is 20% lipid emulsion 1.5 mL/kg bolus.

Mallampati I: soft palate, uvula, fauces, pillars visible; II: soft palate, uvula, fauces; III: soft palate and base of uvula; IV: hard palate only; III-IV predict difficult laryngoscopy.

Oxygen delivery: nasal cannula 1-6 L/min (24-44% FiO2); simple mask 5-10 L/min (35-55%); nonrebreather 10-15 L/min (80-95%); Venturi mask provides fixed FiO2.

Capnography: normal ETCO2 35-45 mmHg; esophageal intubation gives no sustained waveform; bronchospasm gives a shark-fin slope; disconnection gives sudden loss of waveform.

Laryngospasm: 100% O2 with CPAP, jaw thrust, suction, and deepen anesthesia; if persistent, succinylcholine 0.1-0.5 mg/kg IV and prepare for reintubation.

Extubation criteria: awake, follows commands, adequate spontaneous ventilation, stable hemodynamics, protective reflexes, and train-of-four ratio >0.9.

Opioid-induced respiratory depression: respiratory rate <8/min, sedation, and falling SpO2; give naloxone 0.04 mg IV increments and support ventilation.

OSA postoperative precautions: continuous pulse oximetry, head-of-bed elevation, early CPAP if prescribed, and extended monitoring; opioids and sedatives increase obstruction risk.

Pulse oximetry limitations: unreliable with poor perfusion, motion, carbon monoxide, methemoglobin, and nail polish; SpO2 <90% defines hypoxemia and requires airway assessment.

MAP = (SBP + 2 × DBP)/3; target generally ≥65 mmHg for organ perfusion; MAP = CO × SVR (+ CVP).

Cardiac output = HR × SV; normal 4-8 L/min; cardiac index = CO/BSA; normal 2.5-4 L/min/m2.

Shock types: hypovolemic (hemorrhage, dehydration), cardiogenic (MI, arrhythmia), distributive (sepsis, anaphylaxis), obstructive (PE, tamponade, tension pneumothorax).

Septic shock: norepinephrine first-line vasopressor; anaphylaxis: epinephrine 0.3-0.5 mg IM adult; vasodilatory hypotension: phenylephrine or norepinephrine.

Postoperative hypertension causes: pain, bladder distension, hypoxemia, hypercapnia, anxiety, hypothermia, and medication withdrawal; treat cause before adding antihypertensives.

Symptomatic bradycardia: atropine 0.5 mg IV every 3-5 min, maximum 3 mg; consider pacing or epinephrine infusion if unresponsive; check oxygenation first.

CVP normal 2-8 mmHg; trend and waveform matter more than a single value; CVP does not reliably predict fluid responsiveness.

Arterial line square-wave test: underdamped waveform overshoots and overestimates systolic pressure; overdamped waveform underestimates systolic; check tubing, bubbles, and catheter position.

PONV risk factors: female sex, nonsmoking, history of PONV or motion sickness, postoperative opioids, volatile anesthetics; Apfel score 0-4 guides prophylaxis.

PONV rescue: ondansetron 4 mg IV, dexamethasone 4-8 mg IV, droperidol 0.625-1.25 mg IV, metoclopramide 10 mg IV; use multimodal therapy from different classes.

Malignant hyperthermia: hypercarbia, tachycardia, muscle rigidity, hyperthermia, acidosis, hyperkalemia; stop triggers, dantrolene 2.5 mg/kg IV, cool, and treat arrhythmias.

Anaphylaxis: hypotension, bronchospasm, urticaria, angioedema; epinephrine 0.3-0.5 mg IM adult, 0.01 mg/kg IM pediatric, fluids, oxygen, and airway support.

LAST: stop injection; 20% lipid emulsion 1.5 mL/kg bolus then 0.25 mL/kg/min; seizures and ventricular arrhythmias may occur; avoid vasopressin and calcium channel blockers.

Postoperative neck hematoma: airway obstruction can progress rapidly; call for help, open the wound, and prepare for emergent intubation or surgical airway.

Hypothermia: core temperature <36°C; forced-air warming, warm IV fluids, and humidified gases; shivering increases oxygen consumption and carbon dioxide production.

Urinary retention: bladder scan, straight catheterization if painful or volume >500 mL; common after spinal anesthesia, opioids, and pelvic surgery.

Discharge instructions include medications, pain management, incision care, activity restrictions, diet, follow-up, and warning signs such as fever, bleeding, or worsening pain.

Teach-back: patient restates instructions in own words; confirms comprehension and identifies gaps, especially with low health literacy or language barriers.

Informed consent elements: capacity, voluntariness, disclosure, understanding, and signature; the provider obtains consent and the nurse verifies and witnesses per policy.

ASPAN standards cover assessment, monitoring, staffing, discharge criteria, education, and quality improvement across preanesthesia, Phase I, Phase II, and extended care.

Universal protocol: preprocedure verification, site marking, and time-out immediately before procedure; team confirms patient, procedure, site, and consent.

HIPAA: protect PHI, share only minimum necessary information, and avoid discussing patient details in public areas or unsecured electronic channels.

Advocacy: verify patient identity, allergies, and procedure; speak up when safety concerns arise and escalate through chain of command.

CPAN certification requires current RN licensure, perianesthesia experience, and passing exam; recertification uses continuing education or exam.